Geographic Determinants of Restorative Care: Regional Disparities in Post-Mastectomy Breast Reconstruction Within the Brazilian Public Health System (2021-2025)
Fernando Augusto Siuta dos Santos, Giulia Scain, Julia Loureiro Chaves Cé, Stéphanie Klein Brum, Mariana Weremeier Weber, Martina de Sá, Solana de MeloPURPOSE
Breast cancer is the leading cause of cancer-related mortality among women in Brazil. Federal legislation (Law 12.802/2013) mandates immediate breast reconstruction after mastectomy whenever clinical conditions allow. Despite this legal framework, the practical access to restorative surgery remains profoundly unequal. This study aims to analyze the regional disparities in breast reconstruction rates following radical mastectomies within the Brazilian Public Health System (SUS) over a 5-year period.
METHODS
A nationwide ecological study was conducted using publicly available data from the Hospital Information System of the Brazilian Unified Health System, accessed through DATASUS, between January 2021 and December 2025. The study compared the volume of radical mastectomies with oncology-specific lymphadenectomy against the volume of breast reconstructions. The Breast Reconstruction Rate (BRR) was calculated and stratified by Brazil's five macro-regions (North, Northeast, Central-West, Southeast, and South) and 27 federative units.
RESULTS
A total of 28,923 radical mastectomies and 9,589 reconstructions were recorded nationwide, resulting in an overall BRR of 33.15%. Significant geospatial inequity was observed: the Southeast region presented the highest BRR (38.19%), followed by the Northeast (35.87%) and South (30.58%). Conversely, the Central-West (21.72%) and North (16.04%) regions exhibited the lowest rates. In critical states like Sergipe (5.49%), Amazonas (9.29%), and Paraíba (9.24%) less than one in ten women received surgical rehabilitation, while the state of São Paulo alone accounted for nearly 40% of all reconstructions performed in the country, underscoring a severe centralization of surgical expertise.
CONCLUSION
Despite existing statutory requirements, the “reconstruction gap” remains a persistent reality in Brazil. The findings demonstrate that the “right to reconstruction” is frequently dictated by a patient’s geographic location rather than clinical necessity. The stark contrast between the Southeast and North/Central-West regions suggests a centralization of high-complexity oncological infrastructure and specialized human resources, highlighting an urgent need for targeted public policies to ensure health equity and strict compliance with federal legislation across all Brazilian territories.