Assessing Recent Trends in Lumpectomy and Concomitant Oncoplastic Procedures: A National Insurance Database Analysis

BACKGROUND: Following the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-06 trial, breast-conserving therapy (BCT) has increasingly replaced mastectomy for eligible patients. Concurrently, oncoplastic surgical techniques have evolved to address contour deformities associated with lumpectomy and adjuvant radiation. While utilization of BCT has been well described, national trends in oncoplastic reconstruction remain less well defined. This study evaluates temporal trends in post-lumpectomy reconstruction using a large national insurance database. PATIENTS AND METHODS: The PearlDiver™ national claims database was queried for patients undergoing lumpectomy (Current Procedural Terminology (CPT) 19301) from 2010 to 2020. Patients were stratified into four cohorts: lumpectomy alone, lumpectomy with mastopexy (LM; CPT 19316), lumpectomy with reduction mammaplasty (LR; CPT 19318), and lumpectomy with adjacent tissue rearrangement (LATR; CPT 14301/14302/19366). Primary outcomes included annual procedural volumes and proportional trends. Associations with demographics, comorbidities, and insurance status were analyzed using Welch's analysis of variance (ANOVA) and chi-squared testing. RESULTS: Among 486,368 patients, 92.3% underwent lumpectomy alone, while 4.6% underwent LATR, 1.6% LR, and 1.0% LM. Mean age differed significantly across cohorts (p < 0.001), with LR patients being youngest. Overall lumpectomy volume increased 27% over the decade, while lumpectomy with reconstruction increased 249%, driven by a 250% increase in LATR and a 622% increase in LR. Comorbidity burden was highest in the lumpectomy-alone cohort, whereas obesity and tobacco use were more prevalent in LR patients. Insurance distribution differed among groups (p < 0.001). CONCLUSIONS: Oncoplastic reconstruction following lumpectomy has increased from 2010 to 2020, led by adjacent tissue rearrangement techniques. These trends reflect an expanding emphasis on aesthetic and quality-of-life outcomes in breast-conserving therapy.