Scientific Abstract Presentations: Breast Session 4 Friday, October 10 Fri, Oct 10 10:30 a.m.-12:30 p.m. CDT

Purpose: Patients in resource-limited neighborhoods and those living farther from hospitals face increased barriers to elective surgical care, leading to higher rates of poor postoperative outcomes. Existing literature focuses on how travel distance affects access to post-mastectomy breast reconstruction, yet limited data explores how these factors influence outcomes. The deep inferior epigastric perforator (DIEP) flap, the gold standard for autologous breast reconstruction, yields high patient satisfaction but requires intensive follow-up, which may be impacted by geographic barriers. This study examines how travel distance and neighborhood socioeconomic status affect postoperative outcomes in DIEP flap breast reconstruction.

Methods: A retrospective review identified patients who underwent DIEP flap breast reconstruction at a quaternary institution between January 2021 and September 2024. Patients' residential ZIP codes were used to determine the distance to our institution and to assign national and state-specific Area of Deprivation Index (ADI) scores. Primary outcomes included surgical complications (infection, seroma, hematoma, wound dehiscence, flap loss), medical complications (deep vein thrombosis, pulmonary embolism, urinary tract infection), and reoperation rate. Patient characteristics and complication rates were compared across travel distance and ADI scores using t-tests and linear regression models.

Results: A total of 342 patients were included in the study, of whom 85.3% were White, with an average Elixhauser Comorbidity Index of 4.04 (SD 6.01). The mean age at the time of surgery was 51.4 (SD 10.1) years, and 41% of patients received radiation prior to reconstruction. The rates of any medical or surgical complications were 16.3% (n=56) and 52.1% (n=178), respectively. Wound infections (n=93, 27.1%) and dehiscence (n=54, 15.8%) were the most common surgical complications. Unplanned readmission rates were 12.8% (n=44) with a 19.2% (n=66) reoperation rate across the cohort.

The average distance traveled was 70.2 miles, ranging from 2 to 320 miles. Patients who experienced surgical complications traveled an average of 12.4 miles more than those without surgical complications (P<0.05). Specifically, patients who suffered total flap loss (n=6, 1.7%) resided significantly further from our institution, traveling an additional 67 miles on average (P<0.01). Positive linear correlations were observed between travel distance and ADI scores with rates of seromas, hematomas, surgical site infections, and wound dehiscence. No clinically significant differences in medical complications and reoperation rates based on travel distance or ADI were observed. Notably, each one-unit increase in national and state-specific ADI scores corresponded to travel distance increases of 0.82 miles (P<0.01) and 6.94 miles (P<0.01), respectively, suggesting that patients from more deprived neighborhoods traveled longer distances for care.

Conclusion: Patients living farther from their surgical center and in areas with higher neighborhood deprivation indices face increased risks of surgical complications following DIEP flap breast reconstruction. Additionally, those in limited-resource neighborhoods often travel greater distances for surgical and follow-up care, incurring direct care costs and indirect expenses like lost wages and travel costs, which collectively limit healthcare options. These challenges underscore the urgent need for improved postoperative support and more accessible surgical services to ensure all patients have equitable access to high-quality care, regardless of geographic and socioeconomic barriers.

Background: The P1 technique is a modified prepectoral approach in implant-based breast reconstruction involving a thin strip of pectoralis muscle that covers the implant superiorly. To understand its clinical safety, we compared post-operative outcomes among patients who underwent first-stage breast reconstruction with tissue expander (TE) placement in the P1 versus prepectoral plane.

Methods: A retrospective chart review was conducted on patients who underwent post-mastectomy tissue expander (TE) placement followed by implant-based reconstruction using either partial submuscular (P1) or prepectoral placement. All procedures were performed by a single surgeon, with a minimum follow-up of 60 days after implant placement. Data was collected on patients' demographics, comorbidities, oncologic treatment history, operative details, and complications following TE placement and second-stage breast reconstruction. Propensity-score matching analysis was performed using patients who underwent prepectoral TE placement to generate an appropriately matched comparison cohort for statistical analysis, with Chi squared analysis and Fisher's exact test to assess for significant differences between groups.

Results: 67 patients fit the study criteria. From that group, 32 patients were matched between the two groups for a total of 64 patients. Post-match, the P1 technique had significantly lower rates of seroma following TE compared to the prepectoral technique (9.4% vs 47.0%;p=0.0008). Additionally, there were no significant differences in infection (15.6% vs 28.1%;p=0.22), dehiscence (3.1% vs 15.6%;p=0.20), hematoma (6.3% vs 0.0%;p=0.49), and mastectomy skin necrosis (3.1% vs 9.4%;p=0.61) following TE placement.

Further, when analyzing complications following second-stage reconstruction, there were no significant differences between P1 and prepectoral patients in the occurrence of postoperative infection, dehiscence, seroma, and hematoma (p>0.05). Those in the P1 cohort had comparable rates of prolonged pain–defined as the endorsement of breast pain greater than 60 days following implant placement (15.6% vs 12.5%, p=1.00)–while also having significantly lower rates of referral to physical therapy when compared to those in the prepectoral cohort (18.8% vs 50.0%, p=0.009).

Notably, patients who underwent P1 reconstruction experienced significantly lower rippling or stepoff following implant placement (mild rippling: 37.5% vs 31.3%; moderate rippling: 0.0% vs 40.6%; p=0.0002). The median number of fat grafting procedures was 1.0 (IQR: 0–1) in the P1 group and 1.0 (IQR: 1–2) in the prepectoral group. The mean number of procedures was slightly higher in the prepectoral group (1.16 ± 0.72) compared to the P1 group (0.97 ± 0.69). However, a Wilcoxon rank-sum test showed no statistically significant difference between groups (Z = -1.33, p=0.184).

Conclusion: The P1 technique demonstrates a comparable safety profile to traditional prepectoral placement, with notably lower rates of breast implant rippling which potentially may increase patient satisfaction and decrease the necessity for aesthetic reoperation. Our findings suggest that the P1 approach may offer a promising alternative, reducing specific complications such as seroma while maintaining overall safety.

Background: Although primary care engagement has been shown to improve outcomes in other surgical settings, limited research exists on the impact of primary care visits on outcomes in breast reconstruction surgery. This study examines the effect of perioperative primary care utilization and care fragmentation on outcomes following autologous breast reconstruction.

Methods: A retrospective chart review was conducted on patients undergoing autologous breast reconstruction after mastectomy for breast cancer or elevated cancer risk between 2017 and 2022. Clinical data and surgical outcomes were collected from the electronic medical record. Patients were categorized based on primary care provider (PCP) status and further classified into fragmented or non-fragmented care based on whether their PCP was affiliated with our institution. Descriptive statistics and multivariate regression models used for analysis.

Results: A total of 264 patients were included in the study: 214 (81.1%) had a PCP, while 50 (18.9%) did not. Among those with a PCP, 142 (67.3%) had fragmented care (FC), and 72 (33.6%) with non-fragmented care (NFC). Patients without a PCP were younger at the age of 47.4 years, compared to 53.0 years in the NFC group and 51.7 years in the FC group (p=0.011). Patients without a PCP also had the highest rates of mastectomy skin necrosis compared to those in the NFC and FC groups (26.0% vs. 12.5% vs. 8.5%, respectively; p = 0.007). Furthermore, those with FC had significantly reduced odds of skin necrosis compared to those without a PCP (OR = 0.295, p=0.009). Additionally, those with FC had significantly higher rates of donor site infection than both the NFC group and those without a PCP (17.0% vs. 2.8% vs. 10.0%, respectively; p = 0.009). Finally, patients with FC had a significantly shorter length of stay (LOS), with a mean of 2.6 days, compared to those in the NFC (3.14 days) or no PCP groups (2.72 days).

Conclusions: These findings suggest a nuanced impact of primary care status and care fragmentation on complex breast reconstruction surgery outcomes, suggesting benefits of non-fragmented care. Further research is needed to explore the potential for perioperative primary care optimization to enhance patient recovery and minimize complications.

Introduction/Purpose: Autologous tissue transfer with DIEP flap has revolutionized breast reconstruction. However, the donor site continues to be problematic with regard to postoperative abdominal laxity and risk of bulge. Extended intramuscular dissection or complex perforator course can create denervation of the rectus muscle, which places patients at higher risk of complications. Techniques to minimize the risk of bulge or abdominal wall weakness after DIEP flap breast reconstruction have been developed, including short fascial and pedicle lengths. The purpose of this study was to examine the feasibility of DIEP reconstruction with a short fascial incision to improve functional outcomes.

Methods:
189 DIEP flaps in 107 patients were performed between October 2021 and July 2024 by the senior author. All patients were included. Our control group included patients who underwent traditional DIEP flap harvest with fascial incision and pedicle length measuring between 12 to 15 centimeters (cm). We compared these to 25 patients with 48 DIEP flaps with a short fascial incision at or above the arcuate line between 7 and 12 cm, further categorized by ultra-short (<8 cm, n=14), short (8.1 to 10 cm, n=20), and moderate-short (10.1 to 12 cm, n=15) fascial lengths. Operative time, total morphine equivalents (ME) during post-operative stay, length of postoperative stay, and complication rates were analyzed.

Results: Ultra-short, short, and moderate-short fascial incisions had average pedicle lengths of 9.8cm, 11.1cm, and 11.9cm, respectively. We found a significant decrease in average total morphine equivalents (ME) required for postoperative pain control from 101.21 ME ± 168.48 (SD) for patients with traditional fascial incisions to 52.35 ME ± 55.35 for patients with short-fascial incisions (p = 0.02). Average length of stay decreased compared to the traditional fascial incision (1.86 days ± 0.86 vs. 2.67 days ± 1.94 p = 0.002). Operative time was shorter with 453 minutes ± 61.55 compared with 497 minutes ± 93.06 for traditional fascial incisions (p = 0.009). Flap failure rate was 1.07% and anastomotic revision rates were 0.53%. There were no flap failures in the short-fascial group. There was no significant difference in venous coupler size and major/minor complications between groups. Average follow up time was 10.1 months.

Conclusions: Short-fascial incision DIEP flap yields shorter operative time, nearly half the total morphine equivalents during postoperative stay, a shorter length of stay and faster recovery, without compromising flap viability. The short-fascial incision DIEP flap average pedicle length of 10.9 cm was adequate for comfortable microsurgery. All these advantages factor into using a short fascial incision in DIEP flap-based breast reconstruction

Introduction: Compared to breast-conserving therapy (BCT), oncoplastic breast surgery allows for larger resections to maximize oncologic outcome without compromising aesthetics. Few studies compare detection rates of incidental cancers found on these larger resections in oncoplastic surgery compared to the current standard of care, BCT. We aim to report our findings of tumor size, detection rates, and re-excision rates for oncoplastic surgery.

Methods: Consecutive oncoplastic cases from January 2022 to February 2025 were identified. Patient, tumor, and surgical characteristics were retrieved from retrospective chart review. Incidental cancers were defined as a separate focus of invasive cancer or ductal carcinoma in situ (DCIS) not previously identified on biopsy or on preoperative imaging. Descriptive statistics were used to define preoperative and postoperative tumor sizes, rates of incidental cancer detection, and surgical intervention.

Results: We identified 157 patients, with 86 undergoing volume displacement (VD) oncoplastic surgery, and 71 undergoing volume replacement (VR) oncoplastic surgery. Median preoperative size by imaging modality for VD cases was 1.0cm (IQR 0.8, 1.6) for mammography, 2.1cm (1.4, 3.3) for magnetic resonance imaging (MRI), and 1.0cm (0.7, 1.2) for ultrasound. Median postoperative size among VD cases based on pathologic assessment was 1.5cm (0.8, 2.2). Median preoperative size by imaging modality for VR cases was 1.1cm (0.9, 1.8) for mammography, 1.8cm (1.3, 2.9) for MRI, and 1.1cm (0.9, 1.8) for ultrasound. Median postoperative size among VR cases based on pathologic assessment was 1.2cm (0.7, 1.5). Overall incidental cancer detection rate was 5.7%. Of the nine identified incidental cancers among 157 patients, one was a new focus of invasive ductal carcinoma (IDC), two were new foci of invasive lobular carcinoma, and the remainder were additional foci of DCIS on additionally excised margins outside of the initial lumpectomy specimen or present within a specimen for a non-IDC invasive cancer. Among patients with known IDC histologic subtypes, associated DCIS was present in 65.9% of cases. Positive margin rate requiring re-excision was 3.2%.

Conclusions: Our findings demonstrated that mammographic and ultrasound imaging modalities were generally predictive of pathologic tumor size while MRI generally overpredicted size. Additionally, we report early data from oncoplastic resections demonstrating a 5.7% detection rate of additional incidental cancers and clearance of associated DCIS in the setting of invasive cancers with low re-excision rates for positive margins after oncoplastic resection (3.2%) compared to literature values for BCT ranging 20-40%.† Future studies will aim to compare these findings directly with a matched cohort to appropriately compare these detection rates and re-excision rates more formally to BCT.

References: †Zhang Y, Wu J, Huang W, Wang Y, Rivera Galvis L, Chen T, Han B. Pathologic evaluation of lumpectomy resection margins for invasive breast cancer: a single institution's experience. Int J Clin Exp Pathol. 2023 Feb 15;16(2):40-47. PMID: 36910891; PMCID: PMC9993018.

Background: Two-stage breast reconstruction has traditionally involved submuscular tissue expander (TE) placement, but this approach is associated with significant postoperative pain, breast animation deformity, and muscle-related complications. Prepectoral TE placement with acellular dermal matrix (ADM) coverage has emerged as an alternative, potentially reducing these issues while maintaining aesthetic outcomes. However, concerns remain regarding infection risk and long-term safety. This study aims to analyze complication rates and risk factors associated with each approach to inform surgical decision-making. Methods: A preliminary retrospective review who underwent tissue expander-based breast reconstruction at our institution (January 2012 - January 2024) was conducted. Statistical analyses, including chi-square tests, independent t-tests, Spearman correlation, and logistic regression, were performed to assess the relationship between surgical technique, adjuvant therapies, and overall complication rates. Results: This analysis included 184 female patients, with most identifying as White (69.0%), followed by Black/African American (15.8%), Asian (4.3%), and Other (10.9%). The average BMI was 28.58. Smoking history included 65.2% never smokers, 31.0% previous smokers, and 3.8% current smokers. Breast cancer staging varied, with 15.2% diagnosed at stage 0, 22.3% at stage I, 19.0% at stage II, 7.6% at stage III, and 1.1% at stage IV. No significant differences in complication rates were observed between prepectoral and submuscular tissue expander placement (χ² = 0.186, p = 0.666; OR = 1.23, 95% CI: 0.62–2.44), nor were complications associated with mastectomy type, ADM use, or mesh use. Mastectomy tissue weight (t = 0.434, p = 0.665) and final expander fill volume (t = -1.463, p = 0.147) also showed no correlation with complication risk. Adjuvant chemotherapy (χ² = 0.0, p = 1.0; OR = 1.04, 95% CI: 0.53–2.05) and radiation therapy, whether before (χ² = 1.32, p = 0.25; OR = 1.73, 95% CI: 0.78–3.85) or after (χ² = 0.05, p = 0.82; OR = 0.87, 95% CI: 0.43–1.75) TE placement, did not significantly impact complication rates.
However, a key finding emerged; higher intraoperative fill volumes were significantly associated with an increased risk of complications (t = 2.05, p = 0.045). Spearman's correlation confirmed a weak but statistically significant positive relationship between intraoperative fill volume and complication rates (ρ = 0.184, p = 0.026), suggesting that overaggressive initial expansion may be a modifiable risk factor. Conclusions: Prepectoral TE placement does not appear to increase complication risk compared to the submuscular approach. Traditional risk factors, including radiation and chemotherapy, were not significant predictors of complications. However, intraoperative fill volume emerged as a potential modifiable risk factor. A complete analysis, including the remaining patient cohort and a detailed complication category breakdown, will be conducted to further refine these findings.

References: 1. Panchal, H., Matros, E. (2017). Current trends in postmastectomy breast reconstruction. Plast Reconstr Surg, 140(7S), 7S-13S. 2. Soni, et al. (2022). Complication Profile of Total Submuscular Versus Prepectoral Tissue Expander Placement: A Retrospective Cohort Study. Annals of Plastic Surgery, 88(S5), S439-S442.

Purpose: The choice between submuscular and subfascial implant placement remains a critical decision in breast augmentation, potentially impacting patient outcomes, complication rates and overall patient satisfaction. Recent advancements, including the use of bioabsorbable scaffolds such as Poly-4-Hydroxybutyrate (P4HB, GalaFLEX & GalaFLEX LITE), offer improved soft tissue integrity and long-term aesthetic outcomes (1). This study evaluates the safety, complication rates, and clinical outcomes of 300 consecutive subfascial breast augmentation cases by a single surgeon using P4HB scaffolding in conjunction with highly cohesive fifth and sixth generation silicone breast implants. Methods: A retrospective review of 370 consecutive cases (300 subfascial, 70 submuscular) performed by a single surgeon between January 2023 and February 2025 was conducted. Patient demographics, implant characteristics, postoperative complications, and revision rates were analyzed. Implant placement was either subfascial or submuscular, and all 370 cases incorporated P4HB to enhance soft tissue support. Follow-up duration ranged from six months to two years. Major complications were defined as those requiring reoperation, while minor complications included non-operative concerns such as palpability, pain, or transient discomfort. Results: Among the 370 patients, the mean age was 35 years (range 19–61), and the average BMI was 23.4 (range 16.9–34.3). The most frequently reported minor complication was implant palpability (7%), followed by transient sharp pain along the P4HB scaffold (4%), which resolved within 180 days postoperatively. Major complications necessitating surgical intervention occurred in 2% of cases and consisted of only implant malposition with no capsular contracture (2). There were no reports of scaffold-related infections or hematomas. The incidence of complications demonstrated a downward trend over time, suggesting a learning curve benefit with continued surgical experience using P4HB. Conclusion: This study represents the largest consecutive case series to date analyzing subfascial breast augmentation with P4HB scaffolds. Our findings highlight the safety and effectiveness of this technique, with low major and minor complication rates. The use of P4HB appears to contribute positively to long-term implant stability and soft tissue support, making it a viable alternative to traditional submuscular placement. Further studies with extended follow-up are warranted to validate these outcomes and optimize surgical techniques for enhanced patient satisfaction and aesthetic longevity (3). References: (1) Tijerina VNE, Elizondo RAS, Garcia-Guerrero J. Experience of 1000 Cases on Subfascial Breast Augmentation. Aesthet Plast Surg. 2010;34:16-22. doi:10.1007/s00266-009-9402-4. (2) Li S, Mu D, Liu C, Xin M, Fu S, Xu B, Li Z, Qi J, Luan J. Complications Following Subpectoral Versus Prepectoral Breast Augmentation: A Meta-analysis. Aesthet Plast Surg. 2019;43:890-898. doi:10.1007/s00266-019-01404-7. (3) Gould DJ, Shauly O, Ohanissian L, Stevens WG. Subfascial Breast Augmentation: A Systematic Review and Meta-Analysis of Capsular Contracture. Aesthet Surg J Open Forum. 2020;2(1):ojaa006. doi:10.1093/asjof/ojaa006.

Purpose: The deep inferior epigastric perforator (DIEP) flap continues to be a mainstay treatment option for patients undergoing breast reconstruction. Thorough preoperative evaluation of patients desiring DIEP flap reconstruction is essential for optimizing surgical outcomes. With a prevalence of over 40% in the United States, obesity is one of the most common patient factors surgeons encounter during this evaluation. This study aims to characterize the effects of obesity on patient outcomes following DIEP flap reconstruction, with the hope of broadening the surgical options made available to these patients and their providers. Methods: The authors performed a retrospective review including patients undergoing breast reconstruction with DIEP flaps at a single institution under the direction of one surgeon over a 7-year period. Patient demographics, therapeutic regimens, operative characteristics, and postoperative complications were collected. Using the World Health Organization criteria for obesity, patients were separated into two cohorts for analysis. Complications recorded included infection, hematoma, seroma, tissue necrosis, and dehiscence of surgical sites. Additionally, rates of flap loss and abdominal wall hernia or bulge were recorded. Both individual complication rates and total complications between the normal BMI and high BMI groups were the primary outcomes. Statistical analyses including Chi-Square and t-test were performed accordingly using GraphPad Prism 10.2.3. Results: There were 121 patients identified through this review. The average BMI was 33.5 kg/m2 with a maximum of 54.7 kg/m2. There were 81 patients in the obese cohort and 40 patients in the normal weigh cohort. There was an average of 1.55 complications in the normal weight cohort and 2.36 in the obese cohort (p=0.02). Ten patients had a BMI ≥ 40.0 kg/m2 and suffered an average of 3.10 complications (p=0.019). While breast hematoma was more common in obese patients (8.5%; p=0.04) the remaining complications were not significantly higher.
Conclusion: While patients with obesity may be at greater risk of experiencing complications such as breast hematoma, patients may find this an acceptable risk profile, and thus should be counseled on their candidacy to pursue autologous reconstruction. The authors advocate for continued research into specific factors affecting patient outcomes after these procedures to support equitable care for individuals with obesity.

Our study introduces a novel preoperative scoring system to predict operative time in autologous breast reconstruction using computed tomography angiography (CTA). By quantifying key anatomical and patient-specific factors, we aim to improve operating room (OR) scheduling efficiency and resource allocation.

A retrospective review was conducted on 180 patients who underwent autologous breast reconstruction with 355 flaps between 2023 and 2024. Preoperative CTA scans were scored on a scale of 1 to 10, with lower scores indicating greater technical difficulty. Scores were categorized into three groups: 1-3, 4-6, and 7-10, which dictated scheduling protocols. Operative times were documented and analyzed against these scores.

The preoperative scores demonstrated a moderate negative correlation with operative time (R = -0.454, p < 0.001). Patients in the 1-3 score group had the longest average operative time of 372 ± 44.64 minutes, followed by the 4-6 score group with 358 ± 125.05 minutes. The 7-10 score group had the shortest operative time, averaging 258.57 ± 64.13 minutes. This suggests that higher scores, indicating easier procedures, are associated with shorter operative times. Furthermore, statistically significant difference in operative time (minutes) between the three groups (F(2, 177) = 25.109, p < .001). Furthermore, a statistically significant difference in operative time was observed between the three groups (F(2, 177) = 25.109, p < .001). The effect size (eta-squared = .221) indicates that group membership accounts for a substantial 22.1% of the variance in operative time, reinforcing the predictive power of the scoring system.

Our study demonstrates a significant correlation between preoperative CTA scores and operative time, suggesting that this scoring system can serve as a valuable tool for optimizing OR scheduling. By accurately predicting operative duration, surgeons can allocate resources more effectively, streamline workflows, and improve patient outcomes by minimizing delays and ensuring surgeries are performed with optimal preparation. This approach has the potential to enhance surgical efficiency, improve resource management, and reduce healthcare costs in autologous breast reconstruction.

Background Cyclin-Dependent Kinase (CDK)4/6 inhibitors - such as Palbociclib, Ribociclib, and Abemaciclib - are a new class of drugs providing a targeted approach to treat certain breast cancers, mainly hormone receptor-positive (HR+), HER2-negative (HER2-) cancers in advanced or metastatic stages. CDK4/6 inhibitors prevent progression of cells through mitosis, and their impact on the healing process is incompletely understood. Currently, there are no data available to assess the impact of CDK4/6 inhibitors on surgical outcomes for prepectoral two-stage implant-based breast reconstruction. In this retrospective review, we evaluated surgical outcomes for prepectoral two-stage breast reconstruction in patients who underwent therapy using CDK4/6 inhibitors.

Methods A retrospective review was conducted of all patients who underwent immediate two-stage prepectoral reconstruction at a single center between January 2018 and October 2024. Patients were excluded if they underwent autologous reconstruction, direct-to-implant surgery, delayed reconstruction or had less than three months of follow-up. Collected data included breast cancer laterality, histology, staging, and subtype, as well as receipt of neoadjuvant or adjuvant therapy (e.g. chemotherapy or HER2-targeted therapy). The primary outcome was documentation of the following complications: major infection, hematoma, seroma, mastectomy flap necrosis, and implant removal for any reason. Major complications were further defined as those requiring readmission or a return to the operating room. Statistical comparisons were performed using Chi-square (or Fisher's exact) tests for categorical variables and Wilcoxon rank-sum tests for continuous variables.

Results A total of 472 patients underwent tissue expander placement, with 30 patients receiving CDK4/6 as adjuvant therapy during the expansion phase. The median age of all patients was 46.7 years. Patients who received CDK4/6 inhibitors were more likely to have undergone neoadjuvant chemotherapy (43.3% vs. 28.5%) and the expansion phase of chemotherapy (36.7% vs. 16.4%) compared to those who did not receive CDK4/6 inhibitors (p = 0.0005). The major complication rate was similar between the CDK4/6 inhibitor and the non-CDK4/6 inhibitor groups (26.7% vs 26.3%, p=0.97). Reoperation rates were also comparable at 23.3% in the CDK4/6 inhibitor group vs. 23.1% in the non-CDK4/6 inhibitor group (p=0.97). While major infection rates were not significantly different in the CDK4/6 inhibitor group compared to the non-CDK4/6 inhibitor group (3.3% vs 8.4%, p=0.50), minor infection rates were significantly lower in the CDK4/6 inhibitor group (0.0% vs. 12.4%, p=0.04). Other complications, including capsular contracture, hematoma, seroma, necrosis, and rupture, did not show significant differences between the two groups.

Among 423 patients who completed implant exchange, 25 (5.9%) received adjuvant CDK4/6. The major complication rate was higher in the CDK4/6 group compared to non-users (14.3 vs 8.7, p=0.36). Similarly, major infections occurred in 4.0% of CDK4/6 users compared to 1.0% in non-users (p=0.26). While seroma rates were higher in CDK4/6 users (8.0% vs 1.5%, p=0.08), this difference did not reach statistical significance.

Conclusion CDK4/6 inhibitors were not associated with higher surgical complication rates among patients undergoing immediate prepectoral reconstruction at our institution. Larger, multi-center studies are needed to assess the risk-benefit profile of CDK4/6 inhibitors more accurately in diverse patient populations.

PURPOSE: Following the voluntary recall of textured implants due to their association with Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), plastic surgeons have lost the major benefits conferred by the textured surface-positional stability. This loss is particularly important in submuscular implant placement, which is at greater risk of displacement induced by muscle contraction. To address this challenge, we have engineered a novel smooth-surface breast implant design featuring small cylindrical wells on the outer surface to promote tissue ingrowth and stabilize the implant. We have previously reported that Positionally Stable Smooth Implants (PSSI) demonstrate superior positional stability compared to smooth implants (and comparable to textured), in a subcutaneous in vivo model (which simulated pre-pectoral placement). In this study, we assess PSSI positional stability in a rodent model of submuscular implant placement.

METHODS: Hemispherical miniature 2cc breast implants were fabricated using polydimethylsiloxane and cast in 3D-printed negative molds. A 7.5mm metal marker was embedded into the implant for measurement reference. PSSI implants were designed with wells spanning 2mm width (W) by 1mm depth (D), with a density of 26, 52, or 70 wells per implant. Miniature smooth and textured implants (salt-loss technique) served as controls. Six implants per group were placed under the latissimus dorsi muscle on the bilateral dorsa of female Sprague-Dawley rats. Implant rotation and position was evaluated via microCT at 2, 4, 8, and 12 weeks (margin of error: +/-10 degrees). Cumulative rotation was calculated by summing the calculated rotation between each measurement interval. Animals were sacrificed at 12 weeks, and implant-capsule units were explanted en bloc for histological analysis and quantification of capsule thickness.

RESULTS: Over the 12-week period, PSSI implants exhibited a cumulative rotation of 47.6+/-28.3 degrees, which was significantly lower than smooth implants at 151.5+/-32.1 degrees (p<0.0001) and comparable to textured implants, which rotated 25.4+/-9.8 degrees (p>0.05). Increasing the density of PSSI wells appeared to reduce the rotation, though not statistically significant (W2D1(26), 56.3+/-30.7 degrees; W2D1(52), 51.7+/-34.9 degrees; W2D1(70), 33.8+/-13.6 degrees). MicroCT imaging confirmed tissue infiltration of homogenous density conforming along the PSSI wells at 2 weeks. En bloc explantation of 12-week capsules confirmed robust capsular ingrowth into PSSI wells within the submuscular plane, effectively anchoring the implant to the surrounding tissue. Histological assessment of capsule thickness and collagen density is ongoing.

CONCLUSION: Cumulative rotation measurements confirmed that tissue ingrowth into PSSI wells corresponded in a significant reduction of implant rotation compared to smooth implants. These preliminary data suggest a promising alternative to textured surface breast implants for providing positional stability in the submuscular plane.

Abstract Introduction Lumbar artery perforator (LAP) flaps are a viable alternative for autologous breast reconstruction, particularly for patients with insufficient abdominal tissue or a history of abdominal surgery. While LAP flaps offer distinct advantages in terms of tissue quality and body contouring, their adoption has been limited due to technical complexity and a relatively high complication rate. This study aims to characterize the spectrum of complications associated with LAP flaps and evaluate their role in breast reconstruction.

Methods A retrospective review of 268 LAP flaps performed at our institution was conducted. Patient demographics, comorbidities, surgical details, and postoperative complications were analyzed. Flaps were categorized into four groups: pure unilateral, pure bilateral, adjunct (combined with other flaps), and salvage (used after prior reconstruction failure).

Results A total of 268 LAP flaps were used to reconstruct 274 breasts in 141 patients. Most reconstructions were bilateral (74.6%) or adjunctive (18.3%), with a smaller proportion of unilateral (8.5%) and salvage cases (1.1%). The mean patient age was 50.2 years, and the mean BMI was 25.6. Common comorbidities included hypertension (21.3%) and diabetes (9.2%). The most frequent reconstruction timing was delayed-immediate (62.4%), followed by delayed (31.9%) and immediate (5.7%). Overall complication rates varied by flap category, with the adjunct group showing the highest complication rate (24.5%). Flap failure rates ranged from 6% to 10%, with donor site seroma being the most prevalent issue.

Conclusion LAP flaps provide a valuable option for patients who are not candidates for traditional abdominal-based reconstruction. Despite their technical challenges, they offer favorable aesthetic outcomes and additional body contouring benefits. However, their use is associated with a higher rate of complications, particularly donor site seroma and prolonged ischemia time. Optimizing patient selection, refining surgical techniques, and implementing preoperative imaging strategies can help mitigate these risks. As experience grows, LAP flaps may become more widely accepted as a standard reconstructive option in select patient populations.

Introduction: Glucagon-like peptide-1 (GLP-1) analogue prescriptions have risen sharply over the past two decades, following their initial FDA approval for diabetes in 2005 and the more recent approval of semaglutide for obesity in 2021 (1). A 2024 study reported a more than 700% increase in GLP-1 usage among non-diabetic patients, a trend expected to continue given the ongoing obesity epidemic (2). While GLP-1 agonists are known to influence wound healing, with studies reporting both potential benefits and risks (3,4), their specific effects remain unclear. However, no large-scale study has specifically examined their impact on surgical outcomes in breast reduction. This study aimed to assess potential risks associated with GLP-1 analogue use in patients undergoing reduction mammoplasty.

Methods: In this retrospective cohort study, we utilized the TriNetX Global Collaborative Network to evaluate surgical outcomes in patients undergoing breast reduction surgery with or without GLP-1 analogue exposure. A total of 49,208 patients met the inclusion criteria, including 48,360 non-GLP-1 users and 848 GLP-1 users who were prescribed the medication within six months before or after surgery. Patients with diabetes, tobacco use, or prior radiation therapy were excluded. To further minimize confounding variables, propensity score matching was performed, yielding a final matched cohort of 846 patients per group. Postoperative wound healing-related outcomes, including wound dehiscence, infections, hematomas, necrosis, and scarring, were compared between groups to assess potential differences associated with GLP-1 use.

Results: Our results showed no statistically significant differences in postoperative complications between GLP-1 users and non-users undergoing breast reduction surgery. However, non-significant trends were observed: fat necrosis, wound dehiscence, and infection rates were slightly higher in the non-GLP-1 cohort, while hypertrophic scar formation was marginally higher in GLP-1 users (p = 0.069). Additionally, reduction in nipple sensation trended higher in non-GLP-1 users (p = 0.092).

Conclusion: In our study, the use of GLP-1 analogues does not appear to significantly increase the risk of postoperative complications following breast reduction surgery. These findings suggest that, in the absence of diabetes, GLP-1 analogues may not have a meaningful impact on wound healing. Given that prior studies in both diabetic mice and humans have reported improved wound healing with GLP-1 agonists (5), our results may indicate that this benefit is primarily due to the mitigation of diabetes-related impairments rather than a direct effect of GLP-1 agonists on wound healing. However, our study has several limitations, and further research is necessary to better understand the role of GLP-1 analogues in surgical healing, particularly in non-diabetic patients.

References:

1. Yeo YH, Rezaie A, Hsieh TY, et al. Ann Intern Med. 2024;177(9):1289-1291. doi:10.7326/M24-0019.
2. Aschen SZ, Zhang A, O'Connell GM, et al. Ann Surg. 2024. doi:10.1097/SLA.0000000000006614.
3. Taraschi F, Salgarello M. Aesthetic Plast Surg. 2025. doi:10.1007/s00266-025-04703-4.
4. Roan JN, Cheng HN, Young CC, et al. J Surg Res. 2017;208:93-103. doi:10.1016/j.jss.2016.09.024.
5. Zhang Q, Zhang C, Kang C, et al. Adv Sci (Weinh). 2024;11(39):e2405987. doi:10.1002/advs.202405987.

Background: This investigation aimed to gain a more comprehensive understanding of lifestyle changes enacted by patients following bilateral breast reduction (BBR) surgery.

Methods: A retrospective survey was completed by 135 women who underwent BBR between January 2016 to January 2024. The survey assessed demographics, surgical motivations, exercise, diet, and changes in diagnosed medical conditions and substance use postoperatively. Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) analyses were run to determine if geography and socioeconomic status impacted propensity to experience positive outcomes from breast reduction.

Results: Approximately 86.7% of participants reported feeling healthier post-surgery, with notable improvements in physical activity (72.6%), diet (51.3%), and weight loss (55.6%). QoL scores increased from 5.3 to 7.8 out of ten. Exercise frequency increased, particularly in high-impact activities. Thirty-six percent of patients intentionally changed their diet. There was no association between resection weight and QoL, body image satisfaction, or weight loss, but higher resection weight was associated with an increase in exercise. High ADI/SVI individuals experienced greater weight loss than "Low Deprivation" patients.

Conclusion: BBR encourages positive lifestyle changes, such as increased physical activity and healthier diet. There is no relationship between resection weight and amount of symptom relief experienced after BBR. Individuals living in greater ADI and SVI areas experienced increased weight reduction after surgery. This finding is novel and warrants further study to delineate populations most likely to receive health benefits from breast reduction surgery. Overall, these findings further define the salutary effects of breast reduction procedures on women's health and position the procedure as health-promoting, not merely symptom relieving.

Background: Length of stay (LOS) following breast reconstruction varies based on patient characteristics, surgical technique, and perioperative factors. Identifying independent predictors of prolonged LOS can improve preoperative planning and optimize resource utilization. This study evaluates preoperative and intraoperative factors influencing LOS in patients undergoing autologous reconstructions using a categorical odds ratio-based approach.

Methods: A retrospective analysis of 2011-2023 ACS-NSQIP dataset was conducted, stratifying patients by reconstruction type. LOS was assessed based on preoperative factors (e.g., BMI, diabetes, modified Frailty-5 Index) and intraoperative factors (e.g., operative time, concurrent procedures). Each factor was analyzed independently using odds ratios (ORs) and 95% confidence intervals (CIs) to determine its impact on prolonged LOS.

Results: We reviewed 28,658 reconstructions including free flaps, pedicled TRAM flaps, latissimus dorsi flaps. BMI was a significant predictor of prolonged LOS only in free flaps (p<0.0001) but was not statistically significant in pedicled TRAM (p=0.291) or latissimus dorsi (p=0.526) flaps. Age had a statistically significant relationship with LOS only for free flaps (p=0.0117). Among the modified Frailty-5 Index variables, diabetes was the only independent predictor of prolonged LOS in free flaps (p=0.016). Intraoperatively, concurrent procedures were significantly associated with increased LOS only in latissimus dorsi flaps (p=0.011), while operative time was the strongest intraoperative predictor across all reconstruction types (p<0.0001). Free flap reconstructions had the longest mean operative time (470.54 min) and mean LOS (3.71 days), followed by pedicled TRAM (350.44 min, 3.97 days), and latissimus dorsi flaps (257.27 min, 2.29 days, p<0.0001).

Conclusions: Preoperative and intraoperative factors play a critical role in LOS following breast reconstruction. BMI and diabetes influence LOS in free flap reconstruction, while operative time is a key factor across all procedures. Optimizing perioperative planning may help reduce hospital stays and improve patient outcomes.

Background: Length of stay (LOS) following breast reconstruction varies based on patient characteristics, surgical technique, and perioperative factors. Identifying independent predictors of prolonged LOS can improve preoperative planning and optimize resource utilization. This study evaluates preoperative and intraoperative factors influencing LOS in patients undergoing autologous reconstructions using a categorical odds ratio-based approach.

Methods: A retrospective analysis of 2011-2023 ACS-NSQIP dataset was conducted, stratifying patients by reconstruction type. LOS was assessed based on preoperative factors (e.g., BMI, diabetes, modified Frailty-5 Index) and intraoperative factors (e.g., operative time, concurrent procedures). Each factor was analyzed independently using odds ratios (ORs) and 95% confidence intervals (CIs) to determine its impact on prolonged LOS.

Results: We reviewed 28,658 reconstructions including free flaps, pedicled TRAM flaps, latissimus dorsi flaps. BMI was a significant predictor of prolonged LOS only in free flaps (p<0.0001) but was not statistically significant in pedicled TRAM (p=0.291) or latissimus dorsi (p=0.526) flaps. Age had a statistically significant relationship with LOS only for free flaps (p=0.0117). Among the modified Frailty-5 Index variables, diabetes was the only independent predictor of prolonged LOS in free flaps (p=0.016). Intraoperatively, concurrent procedures were significantly associated with increased LOS only in latissimus dorsi flaps (p=0.011), while operative time was the strongest intraoperative predictor across all reconstruction types (p<0.0001). Free flap reconstructions had the longest mean operative time (470.54 min) and mean LOS (3.71 days), followed by pedicled TRAM (350.44 min, 3.97 days), and latissimus dorsi flaps (257.27 min, 2.29 days, p<0.0001).

Conclusions: Preoperative and intraoperative factors play a critical role in LOS following breast reconstruction. BMI and diabetes influence LOS in free flap reconstruction, while operative time is a key factor across all procedures. Optimizing perioperative planning may help reduce hospital stays and improve patient outcomes.

Background: Length of stay (LOS) following breast reconstruction varies based on patient characteristics, surgical technique, and perioperative factors. Identifying independent predictors of prolonged LOS can improve preoperative planning and optimize resource utilization. This study evaluates preoperative and intraoperative factors influencing LOS in patients undergoing autologous reconstructions using a categorical odds ratio-based approach.

Methods: A retrospective analysis of 2011-2023 ACS-NSQIP dataset was conducted, stratifying patients by reconstruction type. LOS was assessed based on preoperative factors (e.g., BMI, diabetes, modified Frailty-5 Index) and intraoperative factors (e.g., operative time, concurrent procedures). Each factor was analyzed independently using odds ratios (ORs) and 95% confidence intervals (CIs) to determine its impact on prolonged LOS.

Results: We reviewed 28,658 reconstructions including free flaps, pedicled TRAM flaps, latissimus dorsi flaps. BMI was a significant predictor of prolonged LOS only in free flaps (p<0.0001) but was not statistically significant in pedicled TRAM (p=0.291) or latissimus dorsi (p=0.526) flaps. Age had a statistically significant relationship with LOS only for free flaps (p=0.0117). Among the modified Frailty-5 Index variables, diabetes was the only independent predictor of prolonged LOS in free flaps (p=0.016). Intraoperatively, concurrent procedures were significantly associated with increased LOS only in latissimus dorsi flaps (p=0.011), while operative time was the strongest intraoperative predictor across all reconstruction types (p<0.0001). Free flap reconstructions had the longest mean operative time (470.54 min) and mean LOS (3.71 days), followed by pedicled TRAM (350.44 min, 3.97 days), and latissimus dorsi flaps (257.27 min, 2.29 days, p<0.0001).

Conclusions: Preoperative and intraoperative factors play a critical role in LOS following breast reconstruction. BMI and diabetes influence LOS in free flap reconstruction, while operative time is a key factor across all procedures. Optimizing perioperative planning may help reduce hospital stays and improve patient outcomes.

Introduction Breast cancer is the leading cause of cancer-related deaths among women worldwide, with an estimated 298,000 new cases diagnosed in 2023.[1] Surgical treatment with mastectomy or lumpectomy is a cornerstone of breast cancer care. A substantial number of women undergo breast reconstruction after mastectomy or lumpectomy. While breast reconstruction has been shown to improve quality of life without affecting cancer recurrence or survival rates, significant disparities persist in access and utilization. [2–4] This study explores the impact of socioeconomic factors, specifically insurance status and Social Vulnerability Index (SVI), on rates of breast reconstruction in the United States.

Methods A retrospective cohort analysis was conducted using the Epic Cosmos database, comprising records from over 372,000 patients diagnosed with breast cancer and treated with mastectomy or lumpectomy between 2014 and 2024. Patients were categorized into autologous, implant-based, or oncoplastic reconstruction groups based on CPT codes. Insurance status and SVI scores served as key variables. Statistical analyses, including descriptive statistics and Chi square tests, were performed to evaluate associations between demographic factors and breast reconstruction rates. Statistical significance was set at p < 0.05.

Results Between 2014 and 2024, 296,911 breast cancer patients underwent lumpectomy or mastectomy, with 21.35% (n=63,408) opting for reconstruction or oncoplastic reduction. Most patients had an SVI score between 25–50% (n=81,233). Insurance type varied, with 58.3% having commercial insurance. Chi-square analysis showed SVI score and insurance type to be significantly associated increased odds of reconstruction (p < 0.001). Patients with SVI <25% had 8% lower odds of reconstruction, while those with Medicaid, Medicare, or self-pay had 34% lower odds than commercially insured patients.

Conclusion This study highlights disparities in breast reconstruction based on insurance and SVI scores, underscoring the need for targeted interventions. Standardized counseling, patient education, policy reforms, and incentivizing surgeons in underserved areas may improve access. Future research should address barriers to care to enhance outcomes for vulnerable patients. These findings support ongoing efforts to promote equity in reconstructive breast surgery.

1. NIH Surveilance E and ERP. Cancer Stat Facts: Female Breast Cancer.; 2023. Accessed January 29, 2024. https://seer.cancer.gov/statfacts/html/breast.html
2. Zehra S, Doyle F, Barry M, Walsh S, Kell MR. Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis. Breast Cancer. 2020;27(4). doi:10.1007/s12282-020-01076-1
3. Hu ES, Pusic AL, Waljee JF, et al. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship period. Plast Reconstr Surg. 2009;124(1). doi:10.1097/PRS.0b013e3181ab10b2
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). doi:10.1097/00006534-200010000-00010

BACKGROUND Breast cancer patients treated with axillary lymph node dissection (ALND) have an approximate 20-30% lifetime risk of developing upper extremity lymphedema, with multiple different causative factors implicated in the pathogenesis. (1, 2)However, incision placement as a risk factor has not been well studied. In patients undergoing mastectomy, ALND can be performed through the mastectomy incision or through a separate axillary incision, and it is unknown whether the former causes more lymphatic disruption resulting in higher lymphedema rates. The aim of our study was to assess whether ALND through the mastectomy incision versus a separate axillary incision impacts lymphedema rates.

METHODS A retrospective chart review was performed of female patients who underwent mastectomy and ALND between January 2017 and December 2020. Operative characteristics collected included mastectomy incision type, performance of a separate axillary incision, number of nodes removed, and performance of breast reconstruction. The primary outcome of interest was development of lymphedema as defined by ICD-10 codes. Crude rates of lymphedema were compared between groups using chi-squared test, without adjustment for time-to-event differences. Predictors of lymphedema were identified by multivariable logistical regression analysis.

RESULTS Overall, 1,036 patients were included; 553 underwent ALND via the mastectomy incision and 483 underwent ALND via a separate axillary incision. Median age of the cohort was 51 and the median follow up time was 3.9 years from index surgery. More than half of patients had a skin sparing mastectomy (67%) and post mastectomy breast reconstruction (70%). The median number of regional lymph nodes examined in patients who had ALND via the mastectomy incision and via a separate axillary incision was 17 and 18, respectively (p=0.23). Median time to lymphedema diagnosis was 1.3 years. Lymphedema rates between patients who had ALND via the mastectomy incision were not significantly different from those who had ALND via a separate incision (30.0% vs 29.0%, p=0.77). Similarly, multivariable logistical regression showed patients with ALND performed through the mastectomy incision did not have significantly greater odds of developing lymphedema compared to those with a separate incision (Odds ratio [OR] 1.11, p=0.50).

CONCLUSION Patients who received ALND via the mastectomy incision as compared to a separate axillary incision do not have significantly greater rates of lymphedema. A patient specific approach is appropriate when considering lymph node retrieval technique.

REFERENCES 1. Coriddi M, Khansa I, Stephens J, et al. Analysis of Factors Contributing to Severity of Breast Cancer–Related Lymphedema. Annals of Plastic Surgery 2015; 74(1):22-25. 2. Morrell R, Halyard M, Schild S, et al. Breast cancer-related lymphedema Mayo Clinic proceedings 2005 Nov; 80(11).

Purpose: Chatbots have an impressive ability to answer patient inquiries and assist medical personnel, but they are limited by specialty-specific knowledge deficits and a lack of informational integrity. These issues can be addressed by training chatbots for specific work functions. The purpose of this study was to develop a custom-trained chatbot to answer common patient questions following breast surgery.

Methods: A custom chatbot was developed using an advanced language platform trained with internal and public patient information resources. A comparison study was conducted between the chatbot and nurse responses to common patient questions posed after breast surgery. Response tone, comprehension, accuracy, effectiveness, and clarity were evaluated using a Likert scale.

Results: The chatbot significantly outperformed the comparison group's responses across all five measured metrics with large effect sizes in each (p < 0.001; rank-biserial correlation > 0.5). The chatbot achieved a mean overall score of 4.30 out of 5, which was significantly higher than the comparison group's overall mean of 2.96 (p < 0.001; rank-biserial correlation 0.656). The chatbot achieved the largest effect sizes under the comprehension and effectiveness metrics (respective rank-biserial correlation 0.722 and 0.668), demonstrating highest improvement over the comparison's performance in these areas.

Conclusions: The chatbot shows potential to enhance postoperative patient care in breast surgery. The chatbot provided responses that were ranked higher than the comparison group across all measured communication metrics. These findings highlight the potential for chatbots to improve patient counseling, alleviate patient anxiety, increase post-operative patient compliance, and improve patient-provider communication.

Introduction: Enhanced Recovery After Surgery (ERAS) programs have improved the recovery course for patients undergoing autologous breast reconstruction, demonstrating reduced hospital stays and high success rates. While the average length of stay remains around 3 days, growing reports have suggested discharge within 24 to 48 hours to be safe and feasible. This study aimed to evaluate the financial implications of safely discharging patients within 1 day after deep inferior epigastric perforator (DIEP) flap breast reconstruction.

Methods: A retrospective review was performed of patients who underwent free flap breast reconstruction by a single surgeon from November 2021 to October 2024. Data collected included demographics, medical and surgical history, hospital length of stay (HLOS), and facility costs. Facility costs were defined as insurance payments to the hospital. Wilcoxon rank-sum tests with post-hoc Bonferroni corrections compared facility costs based on HLOS. A multivariate regression model assessed for factors associated with cost differences, with insurance type, reconstruction laterality and timing, and HLOS included as potential covariates.

Results: A total of 181 DIEP flaps were performed on 130 patients. Seventy-nine (60.8%) patients underwent unilateral reconstruction and 51 (39.2%) underwent bilateral reconstruction. Forty-four (33.8%) patients underwent immediate reconstruction and 86 (66.2%) underwent delayed reconstruction. Average length of stay was 1.5 days (SD 0.65 days), with 75 (57.7%) patients discharged on post-operative day (POD) 1, 46 (35.4%) on POD2, and 8 (6.2%) on POD3. The cumulative facility payment was $4,344,636.00. Average payments to the hospital were not significantly different between those discharged on POD1, POD2, and POD3 ($33,992.31, $27,768.86, $55,927.54, respectively, ps>0.05). After multivariate regression, insurance type, reconstruction laterality, reconstruction timing, and HLOS were not associated with any cost differences.

Conclusion: POD1 discharge after DIEP flap breast reconstruction is not only safe and feasible, but also cost-effective. Facility payments were not statistically significant with longer HLOS, even after controlling for insurance type, reconstruction laterality, and reconstruction timing.

PURPOSE: During mastectomy, breast sensory nerves are frequently sacrificed, resulting in protective sensory loss. While numerous studies have explored the recovery of tactile sensation, thermal sensation remains understudied. This study represents the largest investigation to date evaluating thermal sensation recovery in patients undergoing mastectomy with immediate alloplastic reconstruction, as well as the first to identify associated risk factors.

METHODS: Patients undergoing mastectomy with immediate alloplastic based reconstruction were prospectively identified. Data on patient demographics, comorbidities, and adjunctive oncologic regimens were collected. Neurosensory testing was performed at the following time intervals: preoperative, 1–6 months, 6–12 months, 12–36 months, and >36 months. Testing was conducted in 5 distinct areas of the breast (superior, medial, inferior, lateral, and nipple areolar complex (NAC)) using hot (52°C) and cold (12°C) packs. Patients were blinded during testing and asked to respond with "hot," "cold," or "unable to tell." Composite scores (percent correct out of 5) were calculated for heat and cold perception in each breast. Subsequently, univariate and multivariate linear regression, controlling for time since mastectomy, were performed to identify predictors of thermal sensory recovery. A mixed-model approach was used to account for repeated measurements from the same patient over time.

RESULTS: A total of 77 patients (136 breasts) were included in the study. The results demonstrated a gradual improvement in thermal sensation over time. In the early postoperative period (1–6 months), only 46.5% of breast regions correctly perceived cold stimuli, and 57.7% accurately detected heat stimuli. However, by >36 months postoperatively, these rates increased to 80.0% and 78.8% for cold perception and heat perception, respectively.

Subanalysis at >36 months revealed that thermal sensory recovery was highest in the superior and medial regions, with over 90% of patients accurately identifying both cold and heat stimuli in these areas. In contrast, the NAC demonstrated the poorest thermal sensory recovery, with only 62.5% correctly perceiving heat and 67.4% perceiving cold by 36+ months.

As a secondary aim, we utilized mixed-model regression to identify predictors of thermal sensory recovery. Higher body mass index (β = -0.014), active smoking (β = -0.123), and both neoadjuvant chemotherapy (β = -0.140) and adjuvant chemotherapy (β = -0.094) were significantly associated with diminished heat perception. For cold perception, only adjuvant chemotherapy (β = -0.086) was identified as a significant negative predictor, corresponding to an 8.6% reduction in cold detection accuracy. Nonsignificant predictors included age, preoperative radiation, adjuvant radiation, hormone therapy, menopausal status, hypertension, and hyperlipidemia.

CONCLUSIONS: Our findings show that thermal sensation gradually improves over time, with nearly 80% of breast regions accurately identifying cold and heat stimuli by 36 months post-reconstruction. However, we found that chemotherapy, particularly adjuvant chemotherapy, was significantly associated with poorer sensory recovery. These insights can inform preoperative counseling, helping patients set realistic expectations for sensory outcomes.

PURPOSE: During mastectomy, breast sensory nerves are frequently sacrificed, resulting in protective sensory loss. While numerous studies have explored the recovery of tactile sensation, thermal sensation remains understudied. This study represents the largest investigation to date evaluating thermal sensation recovery in patients undergoing mastectomy with immediate alloplastic reconstruction, as well as the first to identify associated risk factors.

METHODS: Patients undergoing mastectomy with immediate alloplastic based reconstruction were prospectively identified. Data on patient demographics, comorbidities, and adjunctive oncologic regimens were collected. Neurosensory testing was performed at the following time intervals: preoperative, 1–6 months, 6–12 months, 12–36 months, and >36 months. Testing was conducted in 5 distinct areas of the breast (superior, medial, inferior, lateral, and nipple areolar complex (NAC)) using hot (52°C) and cold (12°C) packs. Patients were blinded during testing and asked to respond with "hot," "cold," or "unable to tell." Composite scores (percent correct out of 5) were calculated for heat and cold perception in each breast. Subsequently, univariate and multivariate linear regression, controlling for time since mastectomy, were performed to identify predictors of thermal sensory recovery. A mixed-model approach was used to account for repeated measurements from the same patient over time.

RESULTS: A total of 77 patients (136 breasts) were included in the study. The results demonstrated a gradual improvement in thermal sensation over time. In the early postoperative period (1–6 months), only 46.5% of breast regions correctly perceived cold stimuli, and 57.7% accurately detected heat stimuli. However, by >36 months postoperatively, these rates increased to 80.0% and 78.8% for cold perception and heat perception, respectively.

Subanalysis at >36 months revealed that thermal sensory recovery was highest in the superior and medial regions, with over 90% of patients accurately identifying both cold and heat stimuli in these areas. In contrast, the NAC demonstrated the poorest thermal sensory recovery, with only 62.5% correctly perceiving heat and 67.4% perceiving cold by 36+ months.

As a secondary aim, we utilized mixed-model regression to identify predictors of thermal sensory recovery. Higher body mass index (β = -0.014), active smoking (β = -0.123), and both neoadjuvant chemotherapy (β = -0.140) and adjuvant chemotherapy (β = -0.094) were significantly associated with diminished heat perception. For cold perception, only adjuvant chemotherapy (β = -0.086) was identified as a significant negative predictor, corresponding to an 8.6% reduction in cold detection accuracy. Nonsignificant predictors included age, preoperative radiation, adjuvant radiation, hormone therapy, menopausal status, hypertension, and hyperlipidemia.

CONCLUSIONS: Our findings show that thermal sensation gradually improves over time, with nearly 80% of breast regions accurately identifying cold and heat stimuli by 36 months post-reconstruction. However, we found that chemotherapy, particularly adjuvant chemotherapy, was significantly associated with poorer sensory recovery. These insights can inform preoperative counseling, helping patients set realistic expectations for sensory outcomes.