Scientific Abstract Presentations: Reconstructive Session 1 Thursday, October 9 Thu, Oct 9 3:30-4:30 p.m. CDT

Introduction While, historically, implant-based reconstruction has been the predominant method of breast reconstruction, the limitations and complications of this technique have led some patients to choose autologous options, particularly after radiation therapy. In some cases, patients will initially undergo implant reconstruction and subsequently elect to undergo autologous conversion at a later time. This study investigates the transition from implant-based to autologous breast reconstruction, emphasizing the factors driving this shift, patient outcomes, and the influence of emerging flap techniques like PAP and LAP on reconstruction decisions. Methods A retrospective review was performed using data from the REDCap database spanning January 2012 to August 2024. The study included 119 patients who converted from implant-based to autologous reconstruction and 1,329 patients who underwent primary autologous reconstruction. The analysis examined patient demographics, comorbidities, reasons for conversion, types of surgeries performed, and BREAST-Q responses to evaluate satisfaction and quality of life. Results Reasons for conversion primarily included capsular contracture, patient dissatisfaction, and complications from prior treatments. Patients who transitioned to autologous reconstruction typically required more revision surgeries compared to those who underwent primary autologous procedures (p=0.002). Notably, newer flap options like PAP (p<0.001) and LAP (p<0.001) were more commonly used in conversion cases, whereas DIEP (p=0.003) was more commonly used for primary autologous reconstruction. While there were no significant differences in preoperative BREAST-Q scores, postoperative satisfaction varied, highlighting the complex nature of reconstruction outcomes. Conclusion Converting to autologous breast reconstruction provides an alternative solution for those experiencing failures with implant-based methods. Utilization of PAP and LAP flaps in this population emphasizes the importance of individualized surgical strategies and indicates that patients may have been able to avoid additional conversion procedures if they had been presented with these alternative flap options earlier in their care. This study offers valuable insights into optimizing reconstructive outcomes by considering patient preferences and advancements in flap techniques.

Background: Skin cancer continues to be the most frequently diagnosed cancer in the United States. Since 1990, the prevalence of melanoma and non-melanoma skin cancer (NMSC) has been steadily increasing.1 NCCN guidelines recommend complete excision of NMSC to preserve function and optimize aesthetic outcomes.2 The gold standard surgical treatment is Mohs Micrographic Surgery (MMS) with a reported cure rate of 99-100%.3 However, MMS requires specialized training and thus is more geographically and financially limited. The traditional technique utilized for skin cancer removal is intraoperative frozen section assessment (IFSA). IFSA is a common histopathological technique that facilitates microscopic analysis of skin cancer margins intraoperatively, guiding surgical decision making.4 Given the high accessibility of IFSA, plastic surgeons can utilize IFSA when MMS is not readily available. In this study, we aim to report the efficacy of plastic surgeon's use of IFSA for NMSC removal.

Methods: We conducted a retrospective chart review study, reporting a single plastic surgeon's experience using the IFSA technique. The primary outcome was cancer recurrence and false negative rate, which was determined by searching the pathology lab's patient database, for IFSA procedures between January 2016 to July 2023. A recurrence was noted when a patient experienced an excision of skin cancer demonstrated to be arising from post-excision scar tissue. Secondary outcomes include defect size, number of stages, operative time, and complications.

Results: There were 1598 IFSA procedures included in the final analysis. The cohort was 40.2% female and the average age was 71.6 years old. The pathology lab identified two recurrences, representing a 0.1% recurrence rate (99.9% cure rate). Eight cases (0.46%) were false negatives for which subsequent reexcision took place. Complete treatment required an average of 1.15 stages to achieve clear margins with an average operative time of 48.5 minutes (n=44). The average defect size was 2.13 cm2, and the complication rate was 3.5%.

Conclusion: Conventional surgical excision for low risk NMSC remains the most widely available treatment, with cure rates potentially exceeding 95%. However, this method does not provide real-time feedback and may lead the surgeon to (1) incompletely excise the tumor or (2) create unnecessarily large defects. MMS utilizes this intraoperative analysis and demonstrates consistently high cure rates of 98-99%.3 However, underserved and rural communities may lack access to Mohs-trained surgeons and histotechnicians.5 Our findings suggest that plastic surgeons can use traditional IFSA as an effective surgical technique in treatment of NMSC with a 99.9% cure rate.

References:

1) Guy GP, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the U.S., 2002-2006 and 2007-2011. Am J Prev Med. 2015;48(2):183-187. doi:10.1016/j.amepre.2014.08.036 2) Schmults CD, Blitzblau R, Aasi SZ, et al. Basal Cell Skin Cancer, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2023;21(11):1181-1203. doi:10.6004/jnccn.2023.0056 3) Stanciu A, Florica CE, Zota A, Tebeica T, Leventer M, Bobirca F. Surgical Outcomes of More Than 1300 Cases of Mohs Micrographic Surgeries from a Private Mohs Clinic in Romania. Chir Buchar Rom 1990. 2020;115(1):69-79. doi:10.21614/chirurgia.115.1.69 4) Loh L, Tiwari P, Lee J, et al. Use of Intraoperative Frozen Section in the Surgical Management of Patients with Nonmelanoma Skin Cancer. J Skin Cancer. 2021;2021:4944570. doi:10.1155/2021/4944570 5) Jhaveri MB. Mohs Micrographic Surgery and Surgical Excision for Nonmelanoma Skin Cancer Treatment in the Medicare Population. Arch Dermatol. 2012;148(4):473. doi:10.1001/archdermatol.2011.2456

Introduction: Microvascular free tissue transfer (FTT) has become a fundamental tool in complex reconstructive surgery. Thromboembolic complications remain the leading cause of flap failure, representing a major threat to the success of FTT procedures (1). This study aims to identify the optimal anticoagulation, antiplatelet, and ambulation protocols to minimize postoperative complications.

Methods: A single-institution, retrospective review was conducted to investigate the association of perioperative anticoagulation, antiplatelets, and ambulation on postoperative complication rates in microsurgical free tissue transfer. Anticoagulation included warfarin, unfractionated heparin, and low-molecular-weight heparin. Antiplatelets included clopidogrel and aspirin. Data was collected at timepoints: pre-operative home medications, 24 hours before surgery, intraoperatively, postoperative days 0-7, and discharge home medications. Post-operative ambulation from days 0-7 was collected. Flap complications analyzed included: flap loss, arterial thrombosis, venous thrombosis, venous congestion, operative takeback, partial flap loss, hematoma, seroma, dehiscence, infection, and fat necrosis. Multivariable logistic regression analysis was used to identify predictors of post-operative complications. Statistical significance was determined as p-value < 0.05.

Results: The study included 497 free flaps performed between January 2012 and December 2021. After controlling for age, sex, and nicotine use, patient ambulation on post-op day 1 was associated with lower odds of arterial or venous thrombosis compared to patients who did not ambulate on post-op day 1 (aOR 0.34, 95% CI 0.17-0.68, p=0.003). Ambulation on post-operative day 1 was associated with 0.55 lower odds of operating room takeback compared to no ambulation on post-op day 1 (aOR 0.55, 95% CI 0.36-0.84, p=0.005). Anticoagulation on post-op day 6 was associated with 1.69 greater odds of returning to the operating room than patients who did not receive anticoagulation on post-op day 6 (aOR 1.69, 95% CI 1.07-2.68, p=0.024). Antiplatelet therapy on post-operative day 7 was associated with 0.64 lower odds of returning to the operating room than patients who did not receive antiplatelet therapy on post-op day 7 (aOR 0.64, 95% CI 0.41-0.98, p=0.041). Patient ambulation on post-op day 7 was associated with 0.66 lower odds of any complication compared to no ambulation on post-op day 7 (aOR 0.66, 95% CI 0.44-0.98, p=0.039).

Conclusions: Early ambulation is associated with reduced postoperative complications and reduced return to operating room, while anticoagulation continued after post-operative day 6 is associated with increased risk of operating room takeback. Antiplatelet therapy on postoperative day 7 decreased the risk of operating room takeback. This may represent an alternative to anticoagulation starting on postoperative day 7. These findings highlight the importance of prompt postoperative mobilization when appropriate and optimal antiplatelet and anticoagulation therapy timing in microsurgical free tissue transfer patients. This study emphasizes the necessity of establishing evidence-based guidelines for postoperative management in patients who undergo free flaps.

References: 1. Archibald H, Stanek J, Hamlar D. Free Flap Donor-Site Complications and Management. Semin Plast Surg. 2022 Dec 19;37(1):26-30. doi: 10.1055/s-0042-1759795. PMID: 36776806; PMCID: PMC9911222.

Background: Complications following primary closure after abdominal perineal resection (APR) remain high, with reported rates reaching 66%. Flap reconstruction methods have significantly reduced post-operative complications. The de-epithelialized V-Y fasciocutaneous flap has proven to be safe and effective for APR closure, particularly in irradiated patients. This study evaluates long-term patient outcomes of the modified de-epithelialized V-Y flap over a ten-year period, expanding on prior research at our institution with a larger case series to provide more robust evidence of its effectiveness.

Methods: This is a retrospective review of patients who underwent V-Y flap reconstruction following APR and neoadjuvant chemoradiation therapy at our institution from 2013 to 2024. Patients with pelvic malignancy and prior radiation who underwent de-epithelialized V-Y gluteal advancement flaps were included; those without medial de-epithelialization were excluded. We analyzed both wound complications (infections, dehiscence, seromas, hematomas, pelvic fluid collections, pelvic abscesses, and cellulitis) and surgical outcomes (reoperation rates, readmissions, and interventional radiology (IR) drain placement). Multivariate logistic regression assessed the influence of medical comorbidities (e.g., BMI, smoking history, hypertension, diabetes, COPD, atrial fibrillation) and operative factors (e.g., operative time, prior abdominal surgery, defect surface area, mesh use) on wound complications, 30-day reoperations, 30-day readmissions, IR drainage, and increased length of stay (LOS).

Results: A total of 83 patients were analyzed, revealing a wound complication rate of 30.1%. The most common complication was pelvic fluid collections (22.9%), followed by dehiscence (21.7%). Within 30 days, 6 patients (7.2%) required reoperation, with 1 for non-wound issues, and 13 patients (15.7%) were readmitted. Of those with fluid collections or abscesses, 10 patients (12.0%) required IR drainage. Regression analysis revealed patients with COPD (p=0.046) or atrial fibrillation (p=0.048) were more likely to have wound complications. Mesh use (n=10) was associated with higher odds of wound complications (p=0.02), 30-day reoperation (p=0.03), 30-day readmission (p<0.001), and increased chance of requiring IR drainage (p=0.01). No variables assessed were associated with increased LOS in multivariable regression.

Conclusion: The modified V-Y flap approach demonstrated relatively low overall wound complication rates. Although no specific comorbidities predicted wound complications, patients with COPD or atrial fibrillation may be less suitable candidates for this procedure due to higher likelihood of readmission or reoperation. Similarly, mesh use was associated with an increased rate of complications and interventions; however, the number of patients was relatively low and patients requiring mesh likely had a larger or more complex defect. Future studies will focus on assessing long-term outcomes and refining techniques to further reduce complications.

Introduction and Purpose: Esophageal replacement (ER) in pediatric patients presents unique challenges due to their smaller anatomy and need for a conduit that will remain functional for decades, unlike many adult oncologic patients. While gastric and colonic interpositions are more common, they have long-term complications including reduced motility, dilation, reflux, and chronic lung disease over time (1). Supercharged jejunal interposition (JI) offers superior long-term function but is technically demanding due to the segmental/variable jejunal vasculature (2). Preoperative computed tomography angiography (CTA) is widely used in microsurgical planning, yet its role in JI remains underexplored (3). This study describes a preoperative imaging protocol integrating CTA and 3D mesenteric reconstruction with both artificial intelligence (AI) and manual segmentation for optimized presurgical planning and targeted dissection.

Methods: For patients undergoing supercharged JI, preoperative CTA of the chest and neck assessed presence and caliber of the internal mammary arteries/veins (IMA/IMV), as well as secondary venous options, including cephalic (CV) and external jugular veins (EJV). CTA with 3D segmentation of the superior mesenteric vasculature mapped jejunal branching patterns. A retrospective review of patients undergoing the preoperative vascular imaging protocol was conducted to evaluate imaging accuracy, surgical decision-making, and intraoperative correlation with preoperative findings.

Results: Between April 2023 and February 2025, 13 patients underwent supercharged JI with CTA-based planning. The median age was 7.1 years (1.5-15.5). Bilateral IMA visualization was achieved in all patients, and all underwent supercharge to the IMA. IMVs were visualized with lower resolution. Ten patients underwent venous anastomosis to the IMV (median coupler size: 1.75mm). The CV was used three times (median coupler size: 2.5mm) due to insufficient IMV size. Of 26 potential vessels, 52% of CVs and 15% of EJVs were insufficient for use. Mesenteric imaging identified significant vascular variability. Preoperative vessel mapping correlated with intraoperative findings and reduced extensive mesenteric dissection.

Conclusions: The incidence of pediatric patients requiring ER is low and our clinical series is already comparable to other series for supercharged JI in the adult population. Preoperative CTA augmented with high-resolution 3D mesenteric vessel reconstruction is helpful in preparation for supercharged JI in pediatric patients. Imaging reliably demonstrates patency and caliber of the IMAs and helps select targets for exploration based on IMV quality. Imaging of CVs and EJVs can help select and identify secondary venous targets when the IMVs are of poor caliper. Additionally, a novel protocol for creating 3D reconstructions of the mesenteric blood vessels aids with conduits design and dissection.

References: 1. Zwaveling S, Groen H, Van Der Zee D, Hulscher J, Gallo G. Long-Gap Esophageal Atresia: a Meta-Analysis of Jejunal Interposition, Colon Interposition, and Gastric Pull-Up. Eur J Pediatr Surg. 2012;22(06):420. doi:10.1055/s-0032-1331459 2. Thompson K, Zendejas B, Svetanoff WJ, et al. Evolution, lessons learned, and contemporary outcomes of esophageal replacement with jejunum for children. Surgery. 2021;170(1):114–125. doi:10.1016/j.surg.2021.01.036 3. Ghattaura A, Henton J, Jallali N, et al. One hundred cases of abdominal-based free flaps in breast reconstruction. The impact of preoperative computed tomographic angiography. J Plast Reconstr Aesthet Surg. 2010;63(10):1597–1601. doi:10.1016/j.bjps.2009.10.015

Introduction: Abdominoperineal resection (APR) for low rectal and anal cancers poses challenging perineal wound defects, particularly for patients following neoadjuvant chemoradiation. Traditional vertical rectus abdominis myocutaneous (VRAM) flaps have proven efficacious but require large abdominal incisions, with donor site hernia rates reported up to 50%. [1] Robotic VRAM offers a minimally invasive alternative by preserving the anterior rectus fascia, potentially reducing donor site complications.

Purpose: To assess rates of abdominal hernia and bulge in patients undergoing robotic VRAM flap harvest and compare to published data of conventional open VRAM harvest. Secondary study outcomes include comparing rates of perineal wound complications, infections, and return to the operating room.

Methods: A retrospective review of all patients who underwent robotic APR with VRAM by a single surgeon from 2021 to 2024 was performed. Demographics, operative data, and complications were analyzed. Donor site hernias were diagnosed via CT imaging. Statistical analysis was performed in R Studio using T-tests or Mann-Whitney U tests for continuous variables, Fisher's Exact tests for categorical variables, Shapiro-Wilk tests for normality, and logistic regression modeling to adjust for covariates.

Results: All patients (n = 17) received neoadjuvant chemoradiation. The incidence of donor site hernia was 23.5%. Of those four hernias, one was symptomatic and required operative repair. No cases of perineal hernias were observed. Perineal wound dehiscence occurred in 23.5% of patients and was managed predominantly with wound care. Perineal infections were observed in 17.6% of patients and 23.5% required return to the operating room. After adjusting for covariates, diabetes was significantly associated with a higher risk of wound infection (p = 0.03), while adjuvant chemotherapy increased the risk of wound dehiscence (p = 0.02). Patients undergoing robotic APR with VRAM were 69% less likely to develop a donor site hernia, compared to data for those undergoing conventional open VRAM (OR = 0.311, p = 0.049). [2]

Conclusion: Robotic APR with VRAM reduces donor site hernia rates compared to traditional harvesting techniques, likely due to anterior rectus fascia preservation. This minimally invasive approach maintains similar perineal reconstruction complication rates while improving donor site outcomes. Robotic VRAM has the potential to redefine standards in APR reconstruction and warrants further discussion, particularly due to its ability to improve patient care. Additionally, its favorable learning curve could further equip plastic surgeons with greater versatility in utilizing an already commonly performed flap.

[1] Mortensen AR, Grossmann I, Rosenkilde M, Wara P, Laurberg S, Christensen P. Double-blind randomized controlled trial of collagen mesh for the prevention of abdominal incisional hernia in patients having a vertical rectus abdominis myocutaneus flap during surgery for advanced pelvic malignancy. Colorectal Dis. 2017 May;19(5):491–500.

[2] Tang AM, Spencer N, Parkins K, Bevan V, Taylor G, Markham D, Drew P, Harries RL. Radiological incidence of donor-site incisional hernia and parastomal hernia after vertical rectus abdominus myocutaneous flap-based reconstruction following colorectal surgery. Colorectal Dis. 2023 Apr;25(4):738-746. doi: 10.1111/codi.16400. Epub 2022 Nov 20. PMID: 36328985.

Autologous fat grafting (AFG) is a widely utilized surgical technique, but fat graft survival rates remain inconsistent and unpredictable, limiting its effectiveness in clinical practice. We have previously demonstrated that vitamin D3 (VD3) improves fat graft retention in a xenograft model. In this study, we explored the mechanisms by which VD3 enhances AFG retention, aiming to inform targeted treatments and optimize therapeutic applications. Inguinally harvested adipose tissue from three female Yucatán pigs was autologously grafted into 16 dorsal sites (5cc per graft). Pig 1 received no treatment; pig 2 received oral VD3 (100K IU) thrice weekly postoperatively; pig 3 received oral VD3 (100K IU) thrice weekly for two weeks preoperatively and continuously postoperatively. Pigs were sacrificed at 3 months, and grafts were evaluated for histological, volumetric, and molecular changes using Hematoxylin and Eosin, Sirius red, immunohistochemistry, and relative quantitation PCR tests. VD3 improved AFG volume retention at 3 months (p < 0.05). Mechanistically, VD3 enhanced adipocyte viability and vascular migration into the graft core, measured by perilipin+ (p < 0.05) and CD31+ (p < 0.01) IHC, respectively. VD3 increased graft extracellular matrix (ECM) composition (p < 0.05) and collagen type III (p < 0.05). VD3-treated grafts showed decreased pro-inflammatory TNF-ɑ expression compared to the control (p < 0.01) and increased pro-regenerative M2 macrophages (p < 0.01). No significant differences were observed in fibrosis (TGF-β, Collagen(I)) or adiposity biomarkers (adipocyte count, adiponectin). Oral VD3 significantly increased fat graft retention, likely by promoting regenerative wound healing and tissue repair. Specifically, the results suggest that VD3 enhances graft retention through ECM remodeling, modulation of inflammation, and improved vascular migration into the graft core. These findings support the potential of VD3 to improve AFG outcomes in large animal models.

Introduction: Postoperative management of lower extremity free flap reconstruction often includes formal dangling protocols to acclimate flaps to gravitational stress, though their clinical benefit remains uncertain (1). Existing literature presents conflicting evidence on whether these protocols reduce complications such as flap necrosis (2). This study evaluates the impact of a structured inpatient dangling protocol on flap outcomes and explores whether protocol omission may be clinically acceptable.

Methods: In this single-center retrospective cohort study, patients undergoing lower extremity free flap reconstruction were categorized by adherence to a formal inpatient dangling protocol. The protocol was defined by ≥3 consecutive days of supervised, limited dangling prior to discharge, typically beginning on postoperative day 5. Patients with no dangle protocol were allowed to lower their affected limb ad lib for brief activities without supervision, beginning on postoperative day 3. Demographics, comorbidities, surgical indications, flap characteristics, operative factors, flap survival, necrosis, and limb salvage were analyzed. Continuous variables (t-tests) and categorical variables (chi-square/Fisher's exact tests) were compared. Subgroup analyses were performed separately for muscle flaps and fasciocutaneous flaps.

Results: Of 124 patients, 71 (57.3%) followed the protocol. Fasciocutaneous flaps were utilized in 58.1% of cases versus 41.1% that received muscle flaps. Common indications included chronic wounds or defects secondary to failed prior soft tissue coverage (41.9%), oncologic resection (13.7%), chronic osteomyelitis (6.5%), and traumatic injuries (25.0%). The dangle group had a higher proportion of muscle flaps (50.7% vs 28.3%, p = 0.012), a lower proportion of fasciocutaneous flaps (49.3% vs 69.8%, p = 0.022), and fewer patients with diabetes (21.1% vs 39.6%, p = 0.025). Cohorts were comparable in age (p = 0.37), sex (p = 0.79), BMI (p = 0.37), smoking status (p = 0.39), and mechanism of injury (24.5% traumatic in the dangle group vs 25.4% in the non-dangle group, p = 0.92). No significant differences were observed in flap loss (1.4% vs 1.9%, p = 0.83), successful limb salvage (97.2% vs 98.1%, p = 0.74), partial necrosis (0% vs 1.9%, p = 0.25), surgical site infections (0% vs 3.8%, p = 0.099), wound dehiscence (21.1% vs 28.3%, p = 0.36), or time to unassisted ambulation (8.9 ± 9.5 vs 10.7 ± 11.4 months, p = 0.45). Subgroup analyses comparing only muscle flaps and only fasciocutaneous flaps similarly had no significant differences in rates of flap loss, successful limb salvage, and partial necrosis (all p < 0.05).

Conclusion: Adherence to a formal inpatient dangling protocol demonstrated no significant improvement in flap survival, partial necrosis or other postoperative outcomes compared to non-protocol management. Across fasciocutaneous and muscle flaps performed for a wide range of indications, outcomes remained equivalent, suggesting that dangle protocol omission may not adversely affect recovery. These findings challenge the necessity of standardized dangling regimens in lower extremity free flap reconstruction and highlight the potential for simplified postoperative hospital courses in this complex population.

References: (1) Lee ZH, Ramly EP, Alfonso AR, et al. Dangle Protocols in Lower Extremity Reconstruction. J Surg Res. 2021;266:77-87. doi:10.1016/j.jss.2021.03.028 (2) McGhee JT, Cooper L, Orkar K, Harry L, Cubison T. Systematic review: Early versus late dangling after free flap reconstruction of the lower limb. J Plast Reconstr Aesthet Surg. 2017;70(8):1017-1027. doi:10.1016/j.bjps.2017.04.001

Introduction: Inflammatory breast cancer (IBC) is the most aggressive form of locally advanced breast cancer, typically treated with trimodal therapy, including neoadjuvant chemotherapy, modified radical mastectomy (MRM), and post-mastectomy radiation. Due to the high risk of recurrence of IBC, breast reconstruction after MRM requires careful consideration to balance oncologic surveillance with minimizing physical trauma. Despite these complexities, limited data exist on long-term oncologic outcomes following breast reconstruction in patients with IBC. This study aims to assess recurrence patterns and survival outcomes in patients with IBC who underwent breast reconstruction compared to those who did not.

Methods: We conducted a retrospective review of our institution's dedicated IBC program database. The database stores diagnostic and treatment data on all patients who have been treated for IBC at our institution from 1996 to 2023. Only patients who received MRM were included in our analysis. Patients with metastatic disease on presentation were excluded. The primary outcome was the percent of disease recurrence and time to recurrence or metastasis. Secondary outcomes included length of follow-up since MRM, and site of recurrence or metastasis. Propensity score matching, cox proportional hazards model, unpaired t-test, and Chi-squared test were used for statistical analysis.

Results: Among 330 patients with stage III IBC, 89 (26.97%) underwent breast reconstruction after MRM, while 241 (73.03%) did not. For reconstructed patients, the median follow-up was 58.38 months (2.3–257.98) from the time of MRM. 44 (49.44%) reconstructed patients experienced recurrence at a median of 17.87 months (0.79–86.3), primarily distant metastases (39, 88.63%) with 5 (11.36%) locoregional. 17 (38.64%) of 44 patients developed recurrences within the first year after MRM. For non-reconstructed patients, the median follow-up was 35.84 months (1.12–334.3). 121 (50.21%) patients developed recurrence at a median of 12.09 months following MRM (0.13 - 213.21), mostly distant metastases (117, 96.69%) with 4 (3.31%) locoregional. Early recurrence within the first year was observed in 60 (49.59%) patients.

Overall, the most common locoregional recurrence sites were the ipsilateral chest wall (62, 18.79%), supraclavicular lymph node (17, 5.15%), and axilla (7, 2.12%). Recurrence rates at these sites did not differ significantly between patients who received reconstruction and those who did not.

Propensity score matching based on race, age at diagnosis, smoking status, hormone receptor status, adjuvant therapy status, and comorbidities (hyperlipidemia, diabetes, and hypertension) was performed between patients who did and did not receive post mastectomy reconstruction. Patients who received reconstruction were not more likely to exhibit cancer recurrence compared with patients who did not receive reconstruction (Hazard Ratio: 0.77, 95% CI: 0.48 - 1.24, p=0.28).

Conclusions: Aggressive treatment modalities and high recurrence rates following IBC may complicate the decision to undergo breast reconstruction. High recurrence rates were observed for all patients regardless of receipt of breast reconstruction following MRM, and there was no difference in recurrence-free survival between these two groups. These findings support the consideration of delayed reconstruction in this high-risk population.

Purpose: Disparities among vulnerable populations exist in breast cancer reconstruction. This study investigates the relationship between race and Social Vulnerability Index (SVI) on outcomes of post-mastectomy breast reconstruction, focusing on disparities present among different reconstructive techniques.

Methods and Materials: A retrospective study was conducted on patients (n=228, 52.6% Black, 45.2% Caucasian, 0.9% Asian, 1.3% other) undergoing first-time post-mastectomy breast reconstruction at a single institution over seven years. Independent t-tests and Chi-square were used to analyze data including demographics, SVI, reconstruction methods, and outcomes. Subgroup analyses were based on reconstructive methods including DIEP flaps, tissue expanders (TE) with DIEP, latissimus dorsi (LD) flaps, TE with LD, direct-to-implant (DTI), and TE with implants.

Results: Black patients had a higher SVI, indicating more social vulnerability (p < 0.001), a higher BMI (p < 0.001), presented at a younger age (p = 0.035), and had higher rates of preoperative chemotherapy (p = 0.004) and radiation (p = 0.045). Black patients were also more likely to have DIEP flaps (p = 0.020) and less likely to have DTI (p = 0.008). Patients undergoing LD flaps had a higher SVI (p < 0.001). Black patients and those in the most vulnerable SVI quartile had longer hospital admissions (p = 0.021, p = 0.048). Subgroup analyses demonstrated patients in the most vulnerable SVI quartile receiving DIEP flaps had a longer hospital admission than all other SVI quartiles (p = 0.012). Black patients receiving TE with LD flaps had increased time to complete reconstruction compared to all other races (p = 0.018).

Conclusion: The relationship between race, SVI, increased comorbidities, and earlier presentation indicates Black patients are more susceptible to adverse health outcomes, including increased time to complete reconstruction and increased length of hospital admission. Addressing these disparities is crucial to enhance care among vulnerable populations.