A Hidden Hurdle: The Plastic Surgery Bottleneck in Breast Cancer Care

Abstract

Timely surgical intervention is critical in breast cancer, with consensus supporting surgery within eight weeks of diagnosis to optimize survival. Immediate breast reconstruction (IBR) has been associated with delays related to insurance status, socioeconomic factors, race, and reconstructive intent. While barriers to accessing IBR have been studied, few investigations have quantified their impact on surgical timing and outcomes. A literature review was conducted using PubMed to identify studies published between 2015 and 2025 that examined time to definitive breast cancer surgery in relation to reconstructive intent, access to IBR, or barriers to reconstruction. Eligible studies included randomized controlled trials, cohort studies, and meta-analyses involving human participants and published in English. Data extracted included study design, patient population, and reported outcomes. Twelve studies met inclusion criteria representing over 1.69 million patients. Across studies, IBR was associated with increased time to definitive surgery compared with mastectomy alone, with reported delays ranging from several days to a few weeks. These delays were statistically significant but generally clinically modest. Patient-, institutional-, and system-level barriers to IBR were identified, including reconstructive surgeon availability, geographic disparities, insurance status, and socioeconomic factors, though operative timing was infrequently evaluated as a primary outcome. IBR is associated with delays in definitive breast cancer surgery, yet the mechanisms remain poorly defined. Identifying and addressing these barriers could reduce surgical delays and potentially impact survival. Our review highlights current gaps in the literature and emphasizes the need for targeted research to optimize timely, equitable access to reconstruction without compromising oncologic outcomes.