BACKGROUND: Risk-reducing mastectomy (RRM) significantly lowers breast cancer risk as a preventive surgery. While racial disparities in breast cancer treatment are well-documented, research on racial differences in the utilization and outcomes of RRM is limited. METHODS: We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program (2008-2022) to identify women who underwent RRM. Patient demographics, comorbidities, surgical characteristics, and 30-day postoperative outcomes were compared between White and racial minority patients, including Black/African American women. RESULTS: Among 1,285 patients, 88% (n = 1,126) self-identified as White and 12.4% (n = 159) as racial minorities, including 5.8% (n = 74) Black. Minority patients were younger than White patients (50.7±11.4 years vs. 52.6±12.6 years
P = .66). Black patients had a significantly higher mean BMI than White patients (33.6±8.4 kg/m² vs. 30.6±8.0 kg/m²
P = .03), and higher prevalence of obesity (65%, n = 48 vs. 47%, n = 524
P = .03) and hypertension (51%, n = 38 vs. 30%, n = 342
P = .007). Racial minority patients were more likely to undergo outpatient surgery (81%, n = 129 vs. 57%, n = 645
P <
.001) and had shorter hospital stays than White patients (0.8±1.3 days vs. 1±2 days
P = .001). Black patients experienced higher rates of superficial incisional infections (9.5%, n = 7 vs. 2.9%, n = 33
P = .18) and overall complications (18%, n = 13 vs. 10%, n = 113
P = .48) CONCLUSION: This multi-institutional study reveals racial disparities in RRM, with minority patients significantly more likely to present with comorbidities and experience higher complication rates. These findings underscore the need for targeted strategies to ensure equitable access to RRM and improve outcomes for minority patients, advancing health equity in breast cancer prevention.