Skip to main content

Advertisement

SpringerLink
Log in

Reducing Disparities: Regional Anesthesia Blocks for Mastectomy with Reconstruction Within Standardized Regional Anesthesia Pathways

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recent data suggest disparities in receipt of regional anesthesia prior to breast reconstruction. We aimed to understand factors associated with block receipt for mastectomy with immediate tissue expander (TE) reconstruction in a high-volume ambulatory surgery practice with standardized regional anesthesia pathways.

Patients and Methods

Patients who underwent mastectomy with immediate TE reconstruction from 2017 to 2022 were included. All patients were considered eligible for and were offered preoperative nerve blocks as part of routine anesthesia care. Interpreters were used for non-English speaking patients. Patients who declined a block were compared with those who opted for the procedure.

Results

Of 4213 patients who underwent mastectomy with immediate TE reconstruction, 91% accepted and 9% declined a nerve block. On univariate analyses, patients with the lowest rate of block refusal were white, non-Hispanic, English speakers, patients with commercial insurance, and patients undergoing bilateral reconstruction. The rate of block refusal went down from 12 in 2017 to 6% in 2022. Multivariable logistic regression demonstrated that older age (p = 0.011), Hispanic ethnicity (versus non-Hispanic; p = 0.049), Medicaid status (versus commercial insurance; p < 0.001), unilateral surgery (versus bilateral; p = 0.045), and reconstruction in earlier study years (versus 2022; 2017, p < 0.001; 2018, p < 0.001; 2019, p = 0.001; 2020, p = 0.006) were associated with block refusal.

Conclusions

An established preoperative regional anesthesia program with blocks offered to all patients undergoing mastectomy with TE reconstruction can result in decreased racial disparities. However, continued differences in age, ethnicity, and insurance status justify future efforts to enhance preoperative educational efforts that address patient hesitancies in these subpopulations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol. 2000;26(1):17–9. https://doi.org/10.1053/ejso.1999.0733.

    Article  CAS  PubMed  Google Scholar 

  2. Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet. 1983;1(8322):459–62. https://doi.org/10.1016/s0140-6736(83)91452-6.

    Article  CAS  PubMed  Google Scholar 

  3. Elder EE, Brandberg Y, Bjorklund T, et al. Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast. 2005;14(3):201–8. https://doi.org/10.1016/j.breast.2004.10.008.

    Article  PubMed  Google Scholar 

  4. Wilkins EG, Cederna PS, Lowery JC, et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2000;106(5):1014–25. https://doi.org/10.1097/00006534-200010000-00010.

    Article  CAS  PubMed  Google Scholar 

  5. Kulkarni AR. Factors associated with acute postoperative pain following breast reconstruction. JPRAS Open. 2021;30:170–170. https://doi.org/10.1016/j.jpra.2016.08.005.

    Article  Google Scholar 

  6. Cheville AL, Tchou J. Barriers to rehabilitation following surgery for primary breast cancer. J Surg Oncol. 2007;95(5):409–18. https://doi.org/10.1002/jso.20782.

    Article  PubMed  Google Scholar 

  7. Wallace MS, Wallace AM, Lee J, Dobke MK. Pain after breast surgery: a survey of 282 women. Pain. 1996;66(2–3):195–205. https://doi.org/10.1016/0304-3959(96)03064-3.

    Article  CAS  PubMed  Google Scholar 

  8. Vadivelu N, Schreck M, Lopez J, Kodumudi G, Narayan D. Invited commentary - Pain after mastectomy and breast reconstruction. Am Surgeon. 2008;74(4):285–96.

    Article  PubMed  Google Scholar 

  9. Spivey TL, Gutowski ED, Zinboonyahgoon N, et al. Chronic pain after breast surgery: a prospective, observational study. Ann Surg Oncol. 2018;25(10):2917–24. https://doi.org/10.1245/s10434-018-6644-x.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hickey OT, Burke SM, Hafeez P, Mudrakouski AL, Hayes ID, Shorten GD. Severity of acute pain after breast surgery is associated with the likelihood of subsequently developing persistent pain. Clin J Pain. 2010;26(7):556–60. https://doi.org/10.1097/AJP.0b013e3181dee988.

    Article  PubMed  Google Scholar 

  11. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain. 2006;7(9):626–34. https://doi.org/10.1016/j.jpain.2006.02.007.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Azad AD, Bozkurt S, Wheeler AJ, Curtin C, Wagner TH, Hernandez-Boussard T. Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes. J Surg Oncol. 2020;122(4):623–31. https://doi.org/10.1002/jso.26070.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Weichman KE, Hamill JB, Kim HM, Chen XX, Wilkins EG, Pusic AL. Understanding the recovery phase of breast reconstructions: patient-reported outcomes correlated to the type and timing of reconstruction. J Plast Reconstr Aesthet Surg. 2015;68(10):1370–8. https://doi.org/10.1016/j.bjps.2015.05.039.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pak LM, Pawloski KR, Sevilimedu V, et al. How much pain will I have after surgery? A preoperative nomogram to predict acute pain following mastectomy. Ann Surg Oncol. 2022;29(11):6706–13. https://doi.org/10.1245/s10434-022-11976-5.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ashburn MA, Caplan RA, Carr DB, et al. Practice guidelines for acute pain management in the perioperative setting an updated report by the American Society of Anesthesiologists task force on acute pain management. Anesthesiology. 2012;116(2):248–73. https://doi.org/10.1097/ALN.0b013e31823c1030.

    Article  Google Scholar 

  16. Tokita HK, Polanco TO, Shamsunder MG, et al. Non-narcotic perioperative pain management in prosthetic breast reconstruction during an opioid crisis: a systematic review of paravertebral blocks. Plast Reconstr Surg Glob Open. 2019;7(6):ARTNe2299. https://doi.org/10.1097/GOX.0000000000002299.

    Article  Google Scholar 

  17. Shamsunder MG, Chu JJ, Taylor E, et al. Paravertebral blocks in tissue expander breast reconstruction: propensity-matched analysis of opioid consumption and patient outcomes. Plast Reconstr Surg. 2023;151(4):542e–51e. https://doi.org/10.1097/PRS.0000000000009981.

    Article  CAS  PubMed  Google Scholar 

  18. Ardon AE, George JE, Gupta K, et al. The use of pectoralis blocks in breast surgery: a practice advisory and narrative review from the Society for Ambulatory Anesthesia (SAMBA). Ann Surg Oncol. 2022;29(8):4777–86. https://doi.org/10.1245/s10434-022-11724-9.

    Article  PubMed  Google Scholar 

  19. Ardon AE, George JE, Gupta K, et al. ASO author reflections: SAMBA’s practice advisory for the use of pectoralis blocks in breast surgery: overview and lingering questions. Ann Surg Oncol. 2022;29(8):4787–8. https://doi.org/10.1245/s10434-022-11765-0.

    Article  PubMed  Google Scholar 

  20. Afonso AM, Tokita HK, McCormick PJ, Twersky RS. Enhanced recovery programs in outpatient surgery. Anesthesiol Clin. 2019;37(2):225–38. https://doi.org/10.1016/j.anclin.2019.01.007.

    Article  PubMed  Google Scholar 

  21. Arsalani-Zadeh R, ElFadl D, Yassin N, MacFie J. Evidence-based review of enhancing postoperative recovery after breast surgery. Br J Surg. 2011;98(2):181–96. https://doi.org/10.1002/bjs.7331.

    Article  CAS  PubMed  Google Scholar 

  22. Fahy AS, Jakub JW, Dy BM, Eldin NS, Harmsen S, Sviggum H, Boughey JC. Paravertebral blocks in patients undergoing mastectomy with or without immediate reconstruction provides improved pain control and decreased postoperative nausea and vomiting. Ann Surg Oncol. 2014;21(10):3284–9. https://doi.org/10.1245/s10434-014-3923-z.

    Article  PubMed  Google Scholar 

  23. Elshanbary AA, Zaazouee MS, Darwish YB, et al. Efficacy and safety of pectoral nerve block (pecs) compared with control, paravertebral block, erector spinae plane block, and local anesthesia in patients undergoing breast cancer surgeries a systematic review and meta-analysis. Clin J Pain. 2021;37(12):925–39. https://doi.org/10.1097/Ajp.0000000000000985.

    Article  PubMed  Google Scholar 

  24. Jacobs A, Lemoine A, Joshi GP, et al. PROSPECT guideline for oncological breast surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2020;75(5):664–73. https://doi.org/10.1111/anae.14964.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Cassi LC, Biffoli F, Francesconi D, Petrella G, Buonomo O. Anesthesia and analgesia in breast surgery: the benefits of peripheral nerve block. Eur Rev Med Pharmacol Sci. 2017;21(6):1341–5.

    Google Scholar 

  26. Zhang ZY, Li ZY, Zhang ZX, Guan XY, Xin MQ. Analgesic efficacy of pectoral nerve blocks in implant-based mammoplasty: a systematic review and meta-analysis. Aesthet Plast Surg. 2022. https://doi.org/10.1007/s00266-022-03135-8.

    Article  Google Scholar 

  27. Ben Aziz M, Hendrix JM, Mukhdomi T. Regional anesthesia for breast reconstruction. StatPearls. 2023.

  28. ElHawary H, Joshi GP, Janis JE. Practical review of abdominal and breast regional analgesia for plastic surgeons: evidence and techniques. Plast Reconstr Surg Glob Open. 2020;8(12):ARTNe3224. https://doi.org/10.1097/GOX.0000000000003224.

    Article  Google Scholar 

  29. Woodworth GE, Ivie RMJ, Nelson SM, Walker CM, Maniker RB. Perioperative breast analgesia a qualitative review of anatomy and regional techniques. Reg Anesth Pain Med. 2017;42(5):609–31. https://doi.org/10.1097/Aap.0000000000000641.

    Article  PubMed  Google Scholar 

  30. Helander EM, Webb MP, Kendrick J, Montet T, Kaye AJ, Cornett EM, Kaye AD. PECS, serratus plane, erector spinae, and paravertebral blocks: a comprehensive review. Best Pract Res Clin Anaesthesiol. 2019;33(4):573–81. https://doi.org/10.1016/j.bpa.2019.07.003.

    Article  PubMed  Google Scholar 

  31. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. Anesth Analg. 2000;90(6):1402–5. https://doi.org/10.1097/00000539-200006000-00026.

    Article  CAS  PubMed  Google Scholar 

  32. Moningi S, Patki A, Padhy N, Ramachandran G. Enhanced recovery after surgery: an anesthesiologist’s perspective. J Anaesthesiol Clin Pharmacol. 2019;35(Suppl 1):S5–13. https://doi.org/10.4103/joacp.JOACP_238_16.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Beletsky A, Burton BN, Finneran JJ, Alexander BS, Macias A, Gabriel RA. Association of race and ethnicity in the receipt of regional anesthesia following mastectomy. Reg Anesth Pain Med. 2021;46(2):118–23. https://doi.org/10.1136/rapm-2020-101818.

    Article  PubMed  Google Scholar 

  34. Mazzeffi MA, Keneally R, Teal C, Douglas R, Starks V, Chow J, Porter SB. Racial disparities in the use of peripheral nerve blocks for postoperative analgesia after total mastectomy: a retrospective cohort study. Anesth Analg. 2022;135(1):170–7. https://doi.org/10.1213/Ane.0000000000006058.

    Article  PubMed  Google Scholar 

  35. Tokita H, Assel M, Simon B, Lin E, Sarraf L, Masson G, Pilewskie M, Vingan P, Vickers A, Nelson J. Regional blocks benefit patients undergoing bilateral mastectomy with immediate implant-based reconstruction, even after discharge. Ann Surg Oncol. 2023;31(1):316–24.

    Article  PubMed  Google Scholar 

  36. Tokita H, Twersky R, Laudone V, Levine M, Stein D, Scardino P, Simon BA. Complex cancer surgery in the outpatient setting: the Josie Robertson Surgery Center. Anesth Analg. 2020;131(3):699–707. https://doi.org/10.1213/Ane.0000000000004754.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Afonso AM, McCormick PJ, Assel MJ, et al. Enhanced recovery programs in an ambulatory surgical oncology center. Anesth Analg. 2021;133(6):1391–401. https://doi.org/10.1213/Ane.0000000000005356.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Johnson AC, Colakoglu S, Reddy A, Kerwin CM, Flores RA, Iorio ML, Mathes DW. Perioperative blocks for decreasing postoperative narcotics in breast reconstruction. Anesth Pain Med. 2020;10(5):e105686. https://doi.org/10.5812/aapm.105686.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wong S, Lombana NF, Falola RA, Park P, Saint-Cyr MH. Decreasing opioids in outpatient breast surgery with an enhanced recovery after surgery program and preoperative education. Plast Reconstr Surg. 2023;151(5):941–7. https://doi.org/10.1097/PRS.0000000000010069.

    Article  CAS  PubMed  Google Scholar 

  40. Beletsky A, Currie M, Shen J, Maan R, Desilva M, Winston N, Gabriel RA. Association of patient characteristics with the receipt of regional anesthesia. Reg Anesth Pain Med. 2023;48(5):217–23. https://doi.org/10.1136/rapm-2022-103916

    Article  PubMed  Google Scholar 

  41. Wiener AA, Hanlon BM, Schumacher JR, Vande Walle KA, Wilke LG, Neuman HB. Reexamining time from breast cancer diagnosis to primary breast surgery. JAMA Surg. 2023;158(5):485–92. https://doi.org/10.1001/jamasurg.2022.8388.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Verdone CG, Bayron JA, Chang C, et al. A tool to predict disparities in the timeliness of surgical treatment for breast cancer patients in the USA. Breast Cancer Res Treat. 2022;191(3):513–22. https://doi.org/10.1007/s10549-021-06460-9.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Chervu N, Darbinian K, Sakowitz S, et al. Disparate utilization of breast conservation therapy in the surgical management of early-stage breast cancer. Clin Breast Cancer. 2023. https://doi.org/10.1016/j.clbc.2023.04.008.

    Article  PubMed  Google Scholar 

  44. Jones SMW. Financial worry in people with cancer: relationship to employment and outcomes. Psycho-Oncology. 2022;31(11):1835–42. https://doi.org/10.1002/pon.6034.

    Article  PubMed  Google Scholar 

  45. Kino S, Sato K, Kawachi I. Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability. Int J Equity Health. 2018. https://doi.org/10.1186/s12939-018-0877-y.

    Article  PubMed  PubMed Central  Google Scholar 

  46. CMS.gov. Chapter II Anesthesia Services. Medicaid National Correct Coding Initiative Policy Manual. Centers for Medicare and Medicaid Services 2023:chap Chapter II. https://www.cms.gov/files/document/medicaid-ncci-policy-manual-2023-chapter-2.pdf

  47. Moores A, Pace NA. The information requested by patients prior to giving consent to anaesthesia. Anaesthesia. 2003;58(7):703–6. https://doi.org/10.1046/j.1365-2044.2003.03189_5.x.

    Article  CAS  PubMed  Google Scholar 

  48. Politi MC, Yen RW, Elwyn G, et al. Encounter decision aids can prompt breast cancer surgery cost discussions: analysis of recorded consultations. Med Decis Making. 2020;40(1):62–71. https://doi.org/10.1177/0272989x19893308.

    Article  PubMed  Google Scholar 

  49. Gaitanidis A, Alevizakos M, Tsalikidis C, Tsaroucha A, Simopoulos C, Pitiakoudis M. Refusal of cancer-directed surgery by breast cancer patients: risk factors and survival outcomes. Clin Breast Cancer. 2018;18(4):e469–76. https://doi.org/10.1016/j.clbc.2017.07.010.

    Article  PubMed  Google Scholar 

  50. Rapp J, Tuminello S, Alpert N, Flores RM, Taioli E. Disparities in surgery for early-stage cancer: the impact of refusal. Cancer Causes Control. 2019;30(12):1389–97. https://doi.org/10.1007/s10552-019-01240-9.

    Article  PubMed  Google Scholar 

  51. Taylor EM, Wilkins EG, Pusic AL, et al. Impact of unilateral versus bilateral breast reconstruction on procedure choices and outcomes. Plast Reconstr Surg. 2019;143(6):1159e–68e. https://doi.org/10.1097/Prs.0000000000005602.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Santosa KB, Qi J, Kim HM, Hamill JB, Pusic AL, Wilkins EG. Effect of patient age on outcomes in breast reconstruction: results from a multicenter prospective study. J Am Coll Surg. 2016;223(6):745–54. https://doi.org/10.1016/j.jamcollsurg.2016.09.003.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Lautenbacher S, Peters JH, Heesen M, Scheel J, Kunz M. Age changes in pain perception: a systematic-review and meta-analysis of age effects on pain and tolerance thresholds. Neurosci Biobehav Rev. 2017;75:104–13. https://doi.org/10.1016/j.neubiorev.2017.01.039.

    Article  PubMed  Google Scholar 

  54. Mullins S, Hosseini F, Gibson W, Thake M. Physiological changes from ageing regarding pain perception and its impact on pain management for older adults. Clin Med. 2022;22(4):307–10. https://doi.org/10.7861/clinmed.22.4.phys.

    Article  Google Scholar 

  55. Montagna G, Morrow M. Contralateral prophylactic mastectomy in breast cancer: what to discuss with patients. Expert Rev Anticancer Ther. 2020;20(3):159–66. https://doi.org/10.1080/14737140.2020.1732213.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Kessels RPC. Patients’ memory for medical information. J R Soc Med. 2003;96(5):219–22. https://doi.org/10.1258/jrsm.96.5.219.

    Article  PubMed  PubMed Central  Google Scholar 

  57. McGuire LC. Remembering what the doctor said: organization and adults’ memory for medical information. Exp Aging Res. 1996;22(4):403–28. https://doi.org/10.1080/03610739608254020.

    Article  CAS  PubMed  Google Scholar 

  58. Lavelle-Jones C, Byrne DJ, Rice P, Cuschieri A. Factors affecting quality of informed consent. BMJ. 1993;306(6882):885–90. https://doi.org/10.1136/bmj.306.6882.885.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Berry MG, Unwin J, Ross GL, Peacock E, Juma A. A comparison of the views of patients and medical staff in relation to the process of informed consent. Ann R Coll Surg Engl. 2007;89(4):368–73. https://doi.org/10.1308/003588407x183391.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Tappen RM, Cooley ME, Luckmann R, Panday S. Digital health information disparities in older adults: a mixed methods study. J Racial Ethn Health Disparities. 2022;9(1):82–92. https://doi.org/10.1007/s40615-020-00931-3.

    Article  PubMed  Google Scholar 

  61. Ferraris G, Monzani D, Coppini V, Conti L, Maria Pizzoli SF, Grasso R, Pravettoni G. Barriers to and facilitators of online health information-seeking behaviours among cancer patients: a systematic review. Digit Health. 2023;9:20552076231210664. https://doi.org/10.1177/20552076231210663.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Wang CP, Mkuu R, Andreadis K, et al. Examining and addressing telemedicine disparities through the lens of the social determinants of health: a qualitative study of patient and provider during the COVID-19 pandemic. AMIA Annu Symp Proc. 2023;2023:1287–96.

    PubMed  Google Scholar 

  63. Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97(7):1283–9. https://doi.org/10.2105/Ajph.2005.080762.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Armstrong K, McMurphy S, Dean LT, et al. Differences in the patterns of health care system distrust between blacks and whites. J Gen Intern Med. 2008;23(6):827–33. https://doi.org/10.1007/s11606-008-0561-9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the surgeons on the plastic surgery service (Drs. Cordeiro, Coriddi, Dayan, Disa, Matros, McCarthy, Rochlin, Shahzad, and Stern), the breast surgery service (Drs. Morrow, Kirstein, Capko, Plitas, Van Zee, Sclafani, Downs-Canner, Godfrey, Lee, Mamtani, Montagna, Sacchini, Heerdt, Gemignani, El-Tamer, Cody III, and Barrio), and the anesthesiologists (Drs. Baqai-Stern, Gauran, Hagen, Hingula, Horine, Jackson, Kim, Legler, Lewis, Lin, Masson, Nadav, Puttanniah, Teng, and Vakassi) for caring for the patients examined in this study.

Funding

This research was funded in part through the NIH/NCI Cancer Center support Grant No. P30-CA008748. Dr. Jonas Nelson reports as having served as a consultant for RTI surgical. Dr. Mehrara reports having received investigator-initiated research awards from Regeneron, Atyr, Integra, and Pfizer and royalty payments from PureTech, and he is a consultant for Mediflix.

Author information

Author notes

  1. Perri S. Vingan and Joanna Serafin are co-first author.

  2. Hanae Tokita and Jonas A. Nelson are co-senior author.

Authors and Affiliations

  1. Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Perri S. Vingan BS, Kevin K. Zhang BA, Minji Kim BS, Robert Allen Jr. MD, Babak J. Mehrara MD & Jonas A. Nelson MD, MPH

  2. Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Joanna Serafin PhD, Leslie Sarraf MD & Hanae Tokita MD

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Lillian Boe PhD

  4. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Tracy Ann Moo MD & Audree B. Tadros MD

Authors
  1. Perri S. Vingan BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joanna Serafin PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lillian Boe PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kevin K. Zhang BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Minji Kim BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leslie Sarraf MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tracy Ann Moo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Audree B. Tadros MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Robert Allen Jr. MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Babak J. Mehrara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hanae Tokita MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jonas A. Nelson MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonas A. Nelson MD, MPH.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 45 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vingan, P.S., Serafin, J., Boe, L. et al. Reducing Disparities: Regional Anesthesia Blocks for Mastectomy with Reconstruction Within Standardized Regional Anesthesia Pathways. Ann Surg Oncol 31, 3684–3693 (2024). https://doi.org/10.1245/s10434-024-15094-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-024-15094-2

Search

Navigation