Scientific Abstract Presentations: Breast Session 8 Saturday, October 11 Sat, Oct 11 5:00-6:00 p.m. CDT

Introduction: Obesity increases the risk of complications in deep inferior epigastric perforator (DIEP) flap breast reconstruction, particularly infection rates and donor site morbidity (1). Efforts to define an appropriate BMI cutoff for DIEP flap candidacy remain controversial. Implant-based breast reconstruction (IBBR) is often considered an alternative, though it also carries higher complication rates with increasing BMI (2). This study compares complication and revision rates in obese patients undergoing DIEP flap versus IBBR.

Methods: A retrospective review was conducted of patients who underwent breast reconstruction at two institutions from 2017 - 2024. Patient demographics, operative details, post-operative complications, and revision surgeries were analyzed. Major complications were defined as those requiring unplanned surgical intervention. Patients were categorized into DIEP flap and IBBR groups and further stratified by obesity status: non-obese (BMI <30), class 1 obesity (BMI 30–34.9), and class 2 obesity (BMI ≥35).

Results: A total of 1,308 patients were included, with 895 undergoing DIEP flap reconstruction and 413 undergoing IBBR. In patients with class 1 obesity, DIEP was associated with a higher rate of minor complications compared to IBBR (50% vs. 20%, p<0.0001), a trend that persisted in class 2 obesity (62.6% vs. 25%, p<0.0001). However, major complication rates did not differ significantly between groups. DIEP patients had significantly higher successful reconstruction completion rates than IBBR patients both in class 1 obesity (98.5% vs. 75%, p < 0.0001) and class 2 obesity (98.9% vs. 84.9%). Additionally, DIEP patients had higher revision rates, with class 1 patients requiring revision in 61.2% of cases vs. 36.7% for IBBR (p<0.0001) and class 2 patients requiring revision in 64.2% vs. 41.5% of cases (p<0.0001).

Conclusion: Despite higher rates of minor complications and revisions, DIEP flap reconstruction consistently demonstrated higher success rates across all BMI categories compared to IBBR. These findings suggest that while DIEP flap reconstruction may require more postoperative adjustments, it provides a more reliable reconstructive outcome for obese patients. Further research is needed to refine surgical decision-making and postoperative care strategies for this high-risk population.

[1] Nelson JA, Sobti N, Patel A, Matros E, McCarthy CM, Dayan JH, Disa JJ, Cordeiro PG, Mehrara BJ, Pusic AL, Allen RJ Jr. The Impact of Obesity on Patient-Reported Outcomes Following Autologous Breast Reconstruction. Ann Surg Oncol. 2020 Jun;27(6):1877-1888. doi: 10.1245/s10434-019-08073-5. Epub 2019 Dec 6. PMID: 31811437; PMCID: PMC8435214.

[2] Srinivasa DR, Clemens MW, Qi J, Hamill JB, Kim HM, Pusic AL, Wilkins EG, Butler CE, Garvey PB. Obesity and Breast Reconstruction: Complications and Patient-Reported Outcomes in a Multicenter, Prospective Study. Plast Reconstr Surg. 2020 Mar;145(3):481e-490e. doi: 10.1097/PRS.0000000000006543. PMID: 32097295.

Introduction: Randomized controlled trials are the gold standard for investigating the safety and efficacy of a new intervention. In particular, clinical trials in aesthetic and reconstructive breast surgery are critical for the advancement of treatment modalities and device development. This study evaluates the factors associated with early discontinuation of breast reconstruction and aesthetic breast surgery related clinical trials.

Methods: A cross-sectional analysis of all breast surgery related clinical trials on the ClinicalTrials.gov registry was performed. Trials were categorized as aesthetic, reconstructive, or both. Clinical trials related to breast cancer surgery only without reconstruction were excluded. Trials listed as "suspended", "terminated", or "withdrawn" were defined as discontinued trials. Trials were then further sub-divided into 7 study topics, which included: (1) anesthesia/pain management, (2) infection control/wound healing, (3) breast implant/tissue expanders, (4) general breast reconstruction, (6) fat grafting, (6) microsurgery, and (7) patient/surgical education. Additional factors examined included intervention type, funding source, enrollment size, subject gender, subject age, trial start date, and location.

Results: A total of 3,658 clinical trials were identified with start dates between January 1994 to July 2024. Of these, 565 trials were included in final analysis. Seventy-eight percent of studies were reconstructive, 8% were aesthetic, and 14% were both. A total of 75 trials were prematurely discontinued, most commonly secondary to low patient accrual (24%), inadequate staffing (12%), industry/manufacturer decision (9%), and institutional regulations (9%). Thirty-nine percent of discontinued trials were device related, followed by drug/pharmaceutical (33%) and surgical technique (21%). Study category, topic, enrollment size, and study location were not associated with early discontinuation. Observational studies were least likely to be discontinued (OR = 0.23 [0.10-0.48], p<0.001). Non-industry funded studies had a higher likelihood of early discontinuation compared to industry funded studies (OR = 2.07 [1.17-3.59], p = 0.011).

Conclusion: Successful completion of clinical trials in aesthetic and reconstructive breast surgery is essential for improving patient outcomes. Our study demonstrates that 13% of clinical trials did not reach fruition, largely secondary to poor patient recruitment and staffing issues. Targeted efforts to help support trial completion is necessary to help improve evidence-based practice within breast surgery.

Purpose: Glucagon-like peptide-1 (GLP-1) agonists have long been used for diabetic glycemic control but have recently increased in popularity as injectable weight-loss drugs. It is well-known that outcomes in plastic surgery procedures improve when weight and glycemic control are optimized preoperatively. However, data on the effects of GLP-1 agonist therapy on plastic surgery outcomes is lacking, particularly within breast reconstruction. This study aims to explore complication rates of GLP-1 agonist use in autologous microsurgical breast reconstruction.

Methods: A national study was conducted using the PearlDiver database. Using procedure codes, all adult female free flap breast reconstruction cases were identified from January 2017 to November 2024. Patients were categorized into those who had taken GLP-1 agonists and those who had not. Demographic and comorbidity data was collected. Univariate and multivariate regression analyses were conducted. Multivariate regression controlled for age, diabetes, obesity, and chemotherapy treatment. Odds ratios (ORs) were calculated, and a p-value less than 0.05 was considered significant.

Results: 12,474 patients who underwent free flap breast reconstruction were included. Of these, 1.7% (n=214) had received treatment with a GLP-1 agonist during the study period. In comparison, 98.3% (n=12,260) had not. Multivariate regression revealed that patients taking GLP-1 agonists had a significantly higher 30-day occurrence of wound dehiscence rate of 13.1% vs 5.5% in the no-GLP-1 group (OR 1.33, p=0.042). When compared to the no-GLP-1 group, patients taking GLP-1 agonists also had a higher 30-day occurrence of seroma (8.4% vs. 2.8%, OR 1.52, p=0.023) and reoperation (10.7% vs 10.4%, OR 1.37, p=0.004). There was no significant difference in 30-day occurrence of other complications, including surgical site infection, non-healing wound, hematoma, or readmission.

Discussion: GLP-1 agonists are becoming increasingly popular in our society. Although they have several proven benefits, their perioperative risk profile is still being studied. This study found that free flap breast reconstruction patients who take GLP-1 agonists have a significantly increased risk of seroma, wound dehiscence, and reoperation. These findings may inform plastic surgeons' preoperative counseling of breast reconstruction patients who are taking these drugs. Additional research is needed to understand better the mechanisms underlying the risks seen in this study. Furthermore, this database study was limited in its ability to determine when these drugs were being taken relative to surgery. Future studies could help elucidate the pre- or post-operative time frame during which it is safest to take GLP-1 agonists.

Background: For breast cancer survivors, undergoing breast reconstruction (BR) after a mastectomy is essential not only in addressing aesthetic concerns, but in improving self-esteem and overall quality of life. In the Middle East, the prevalence and methods of breast reconstruction are influenced by unique demographic, cultural, and healthcare factors. The goal of this systematic review is to assess the demographic characteristics, treatment history, reconstruction techniques, complications, satisfaction, and patient reported outcomes of breast reconstruction in this region.

Methods: We reviewed research articles from PubMed, EMBASE, and Scopus that were published until September 2024 in accordance with the PRISMA guidelines. The search was restricted to English-language studies conducted in Middle Eastern countries. Included studies were involving patients who underwent or were undergoing any type of breast reconstruction after mastectomy or studies focused on breast cancer survivors that explored factors such as decision-making, socio-cultural barriers, and psychological impact to undergo breast reconstruction. Data extracted included study characteristics, patient demographics, breast cancer history and treatment, reconstruction rate and type, complications and outcomes reported by patients. A meta-analysis was conducted using fixed and random-effects models to address potential study heterogeneity, with subgroup analyses using Cochrane's Q test and heterogeneity assessed via the I² statistic. All analyses were performed in R.

Results: Among 547 studies screened for title and abstract, 28 studies representing a total of 3,677 patients were included. Most studies were observational (n=14). The mean ages of patients ranged between 41.2 years to 60.5 years. The predominant cancer form was invasive ductal carcinoma (IDC). Younger, more educated women with a greater awareness of the surgery, demonstrated a higher preference of undergoing breast reconstruction. Procedure cost and lack of adequate information were major barriers to undergo the surgery. Thirteen studies (46%) reported data on patient satisfaction and quality of life. In general, patient satisfaction was high, with factors such as the type of mastectomy, decision-making process involvement and the occurrence of complications having a significant impact. Complications were reported in several studies, with the most common being seroma, partial skin necrosis and ecchymosis. Complication rates were highly dependent on surgical type and chemotherapy exposure, with implant-based techniques associated with higher capsular contracture risk and autologous procedures exhibiting donor site morbidities. A meta-analysis across 12 study arms revealed an overall complication rate of 31.6%. Among these, four studies focused on autologous breast reconstruction, reporting a significantly higher complication rate of 49.3% (p < 0.001) compared to five studies utilizing alloplastic reconstruction, which had a complication rate of 29.8%.

Conclusion: Breast reconstruction plays is essential in enhancing the quality of life and self esteem of breast cancer survivors in the Middle East. Women who are younger, better educated and knowledgeable about the surgery were more inclined to choose it, although barriers like lack of information and cost were significant barriers. Despite some reported complications the majority of patients expressed high satisfaction. Further research in the Middle East should focus on the long-term functional and psychological impacts of breast reconstruction.

PURPOSE

Nipple-sparing mastectomy (NSM) is challenging in patients with macromastia or ptosis. Staged reduction before NSM can optimize outcomes in this population (1). Body mass index (BMI) has been shown to be a predictor of complications following immediate post-mastectomy reconstruction (2). No prior studies have shown how BMI may impact outcomes in patients undergoing staged reduction before NSM with immediate autologous reconstruction. Our study aims to understand how complication rates vary across BMI groups.

METHODS

Patients who underwent a staged reduction before NSM with immediate autologous reconstruction between January 2018 through October 2023 were retrospectively reviewed for demographics, surgical details, and outcomes. Outcomes collected include infection, delayed wound healing, seroma, hematoma, mastectomy skin-flap and nipple-areolar complex necrosis, flap loss, unplanned reoperation, and readmission. Patients were stratified into five BMI categories according to the World Health Organization classifications – normal weight (18.5–24.9), pre-obese (25.0–29.9), and obesity classes I (30.0–34.9), II (35.0–39.9), and III (≥40) – and outcomes were compared. Additional analysis grouped patients into obese (BMI ≥ 30) and non-obese (BMI < 30) categories and compared outcomes.

RESULTS

A total of 30 patients (57 breasts) were analyzed, with a median follow-up of 318 days (range, 20 to 1020 days). The median interval between the two surgeries was 172 days (range, 89 to 776 days). There were no significant differences in BMI before or after reduction (p=0.25). Averaging the BMI at time of reduction and mastectomy, 12 breasts (21.2%) were in the normal weight category, 20 breasts (35.1%) in the pre-obese category, 18 breasts (31.6%) in the obesity class I category, and 7 breasts (12.3%) in the obesity class II category. There were no patients with class III obesity in our cohort. The groups differed significantly in race (p<0.001), diabetes (p=0.002), smoking status (p=0.001), and mastectomy incision type (p=0.023). The majority of pre-obese and obese class I patients identified as White (80.0% and 83.3%), whereas most obese class II patients identified as Black (71.4%). Diabetes was observed only in obese class II patients (28.6%), while current smoking was exclusive to normal-weight patients (16.7%). For mastectomy incisions, all normal-weight patients used the inframammary-fold approach, while other BMI groups, though primarily using the same technique, also utilized peri-areolar, vertical, and Wise-pattern incisions. When comparing outcomes, there were no differences in overall or individual complication rates across BMI groups (p=0.098). When stratified into obese and non-obese categories, obese patients had higher risk of post-NSM infection (p=0.039) and the development of any complication after NSM (p=0.020). On multivariate regression analysis controlling for BMI, race, diabetes, smoking status, and NSM incision, obesity was identified as an independent predictor for development of any post-NSM complication (OR=1.18, p=0.045).

CONCLUSIONS

Among patients undergoing staged breast reduction before NSM with immediate autologous reconstruction, we found that patients with a BMI higher than 30 had a significantly higher risk of developing post-NSM complications. In the setting of a staged procedure, this highlights an opportunity for preoperative interventions to optimize the BMI of these patients to improve outcomes.

REFERENCES

1.Awaida-CJ,-Bernier-C,-Bou-Merhi-JS,-et-al.-Staged-mastopexy-before-nipple-sparing-mastectomy:-Improving-safety-and-appearance-in-implant-based-and-autologous-breast-reconstruction.-Plastic-&-Reconstructive-Surgery.-Published-online-June-19,-2023.-doi:10.1097/prs.0000000000010823

2.Srinivasa-DR,-Clemens-MW,-Qi-J,-et-al.-Obesity-and-breast-reconstruction:-Complications-and-patient-reported-outcomes-in-a-multicenter,-Prospective-Study.-Plastic-&-Reconstructive-Surgery.-2020;145(3).-doi:10.1097/prs.0000000000006543

Background: Since its introduction, skin-sparing mastectomy (SSM) has revolutionized oncologic breast surgery by optimizing aesthetic outcomes. Various incision techniques have been utilized to facilitate oncologic resection while preserving reconstructive potential. Among these, the Wise pattern and breast-splitting incisions are commonly employed, each with distinct advantages and surgical considerations. While prior studies have primarily compared complication rates between these techniques, limited data objectively assess their aesthetic outcomes. This study aimed to provide a comprehensive comparison of aesthetic and clinical outcomes between Wise pattern and breast-splitting incisions in SSM with immediate tissue expander reconstruction. Methods: A retrospective cohort study was conducted at a high-volume academic institution, analyzing 294 breasts (167 patients) from 2015 to 2023. Patients undergoing SSM with immediate tissue expander reconstruction were categorized into two cohorts based on mastectomy incision type: Wise pattern (n=129) and breast-splitting (n=165). Aesthetic outcomes were assessed using a validated questionnaire evaluating symmetry, volume, scar quality, shape, contour, and overall appearance. The survey was distributed via REDCap to 7 attending plastic surgeons and 15 trainees. Statistical analyses included the Wilcoxon rank-sum test, Pearson's chi-square test, and Cox proportional hazards model. All statistical analyses were performed using BlueSky Statistics © 2024. Results: Wise pattern incisions demonstrated superior aesthetic outcomes, with significantly higher ratings in volume symmetry (p=0.001), shape and contour (p<0.001), scar quality (p<0.001), and overall appearance (p<0.001). No significant differences were observed in inframammary fold appearance (p=0.279) or symmetry scores (p=0.727). A shift towards increased utilization of the Wise pattern technique over time was observed (p=0.004), aligning with a preference for improved aesthetic results. Analysis using Pearson's chi-square test indicated that seroma incidence was significantly higher in the Wise pattern cohort (10.1% vs. 3.0%, p=0.013). The Cox proportional hazards model revealed no significant differences in overall complication rates (HR=1.75, 95% CI: 0.90–3.43, p=0.1001), first revision surgery (HR=1.32, 95% CI: 0.85–2.05, p=0.223), or second revision surgery (HR=1.55, 95% CI: 0.70–3.45, p=0.281). Hematoma, dehiscence, and skin necrosis rates were low and did not differ significantly between the groups. The mean (SD) follow-up was 31.2 (26.36) months. Conclusions: This study provides the first validated, objective aesthetic comparison between Wise pattern and breast-splitting incisions in SSM with immediate tissue expander reconstruction. The Wise pattern approach yields superior aesthetic outcomes, particularly in volume, shape, contour, and scar quality, making it the preferred choice for patients with larger, ptotic breasts. Despite a slightly higher seroma rate, complication risks remain low and comparable between techniques. These findings highlight the importance of individualized incision selection to balance aesthetic goals and surgical safety in breast reconstruction. Future studies should explore long-term patient satisfaction and potential refinements in technique to further optimize reconstructive outcomes.

Purpose

Implant malposition is the second most common reason for revision surgery after capsular contracture in breast augmentation and remains one of the leading causes of revision surgery following breast reconstruction.(1,2) In addition to aesthetic concerns, inappropriately positioned implants can cause pain, discomfort and emotional distress. Thus, it is key for surgeons to understand the risk factors associated with this complication. The aim of this systematic review and meta-analysis is to provide evidence of surgical, and implant characteristics associated with implant malposition following primary breast augmentation and reconstructive surgery.

Methods

A literature search was conducted on February 3, 2025, using the PubMed, CINHAL, Scopus, and Cochrane Library databases to identify relevant articles. This systematic review includes observational studies involving adult females who experienced implant malposition following primary breast augmentation and reconstruction. Case reports, case series, reviews, editorials, letters to the editor, animal studies, in vitro studies, as well as studies focused exclusively on transgender patients were excluded. Results were synthesized using random-effects models to generate pooled risk ratios (RRs) with 95% confidence intervals.

Results

A total of 2,032 articles were identified, and 13 studies (36,103 implants) were ultimately selected for review after eligibility screening and quality appraisal. This meta-analysis suggests that prepectoral implant placement has a significantly decreased risk of malposition compared to subpectoral placement (RR= 0.58, CI [0.38,0.87] p = 0.0085) and primary augmentation had less risk compared to reconstruction (RR= 0.78, CI [0.64,0.93] p = 0.0070). However, no significant differences in malposition were found between smooth vs textured implants (RR = 1.27, CI [0.84,1.91] p = 0.249), smooth round vs textured anatomical implants (RR= 1.04, CI [0.27,3.67] p = 0.951), or implants placed in the subpectoral plane compared to dual plane (RR= 0.97, CI [0.12,7.84] p = 0.976).

Conclusion

This systematic review and meta-analysis highlights key surgical and implant related factors associated with implant malposition following primary breast augmentation and reconstructive surgery. The findings suggest that subpectoral implant placement significantly increases the risk of malposition compared to prepectoral placement, and primary augmentation carries lower risk than reconstruction. However, implant texture does not appear to significantly impact malposition rates. These findings can guide patient counseling, inform clinical management and optimize surgical planning to minimize the risk of implant malposition in breast surgery.

References: 1. Fracol M, Qiu CS, Chiu WK, Feld LN, Shah N, Kim JYS. Lateral and Inferior Implant Malposition in Prosthetic Breast Reconstruction: Incidence and Risk Factors. Plast Reconstr Surg Glob Open. 2020;8(5):e2752. doi:10.1097/GOX.0000000000002752 2. Coroneos CJ, Selber JC, Offodile AC, Butler CE, Clemens MW. US FDA Breast Implant Postapproval Studies. Ann Surg. 2019;269(1):30-36. doi:10.1097/SLA.0000000000002990

Background: Acellular dermal matrix (ADM) is the gold standard tissue substitute used as an adjunct in implant-based breast reconstruction (IBR) and has afforded improved outcomes across many studies compared to IBR without tissue substitutes. A substantial amount of research has been performed to identify alternative and potentially more accessible, cost-effective tissue substitutes that can be used safely and with equivalent outcomes as ADM. OviTex PRS (TELA Bio) is an FDA-approved reinforced ovine tissue matrix and has shown comparable efficacy to ADM in primate models of soft tissue repair (1). However, no clinical studies exist assessing the efficacy of OviTex PRS in human subjects. The purpose of this non-inferiority study is to compare post-operative outcomes between OviTex PRS and ADM in IBR.

Methods: We performed retrospective review of patients who underwent post-oncologic IBR at a large academic institution. Patients were grouped into whether they underwent IBR with AlloDerm ADM (control) or OviTex (experimental). Patients were excluded if they underwent mixed reconstruction (both ADM and OviTex), concomitant flap procedure at time of IBR, or if they underwent only soft tissue augmentation with either product. Covariates of interest included patient demographics (age, body mass index, ASA score) and surgical characteristics (e.g., unilateral vs bilateral, tissue expander vs direct to implant, pre-pectoral vs sub-pectoral placement, etc.). The three types of OviTex were additionally evaluated (permanent, short-term resorbable, or long-term resorbable). Outcomes of interest included post-operative complications including minor infections requiring antibiotics, major infections requiring surgical intervention, fluid collections (seroma/hematoma), wounds/dehiscence, mastectomy flap necrosis, implant exposure, overall operative complications, and explant. All patients had a minimum of 6 months of follow-up. Standard statistical analysis was performed with significance set to p < 0.05.

Results: 242 patients who met inclusion criteria underwent IBR of a total of 429 breasts with either ADM (n=115) or OviTex (n=127) between August 2021 and August 2024. Within the OviTex group, 37 patients underwent IBR with the permanent variant, 12 patients with short-term resorbable, and 78 with long-term resorbable. There was no impact of OviTex type on any of the evaluated post-operative outcomes (p=0.37). When comparing ADM versus OviTex in IBR, there was no difference between the groups in any of the evaluated outcomes (p=0.33), specifically as it pertains to operative complications (18.3% vs 18.9%, respectively, p=0.88), explant rate (12.2% vs 14.2%, respectively, p=0.63), or implant salvage rate (33.3% vs 25.0%, respectively, p=0.52). Incidentally, the OviTex group underwent pre-pectoral (p=0.03) and direct-to-implant reconstruction (p<0.001) more frequently than the control group without notable differences in postoperative outcomes.

Conclusions: Our data suggests that OviTex PRS is a safe and reliable option as a supportive tissue substitute in IBR. Our study suggests non-inferiority of OviTex PRS to standard ADM in IBR, representing a possible cost-saving alternative.

References 1. Overbeck N, Beierschmitt A, May BC, Qi S, Koch J. In-Vivo Evaluation of a Reinforced Ovine Biologic for Plastic and Reconstructive Procedures in a Non-human Primate Model of Soft Tissue Repair. Eplasty. 2022;22:e43. Published 2022 Sep 14.

Background Triple-negative breast cancer (TNBC), defined by a lack of estrogen (ER) and progesterone (PR) receptor expression and the absence of human epidermal growth factor receptor 2 (HER2), represents 20% of all breast cancers and is the most aggressive subtype. In the past several years, however, Pembrolizumab has emerged as a promising immunotherapy for TBNC in addition to chemotherapy. Due to the recent approval and relatively limited number of patients, there are currently no prior data available to determine the impact of Pembrolizumab on surgical outcomes after breast reconstruction. In this retrospective review, we evaluated surgical outcomes for two-stage prepectoral breast reconstruction in breast cancer patients who received Pembrolizumab at a high-volume breast center. Methods Retrospective review was conducted of all patients undergoing immediate two-stage prepectoral reconstruction at a single center with at least 3 months of follow-up from January 2018 to October 2024. Autologous reconstruction, delayed reconstruction, and direct-to-implant cases were excluded as were patients that received chemotherapy after implant exchange. Breast cancer laterality, cancer histology, staging, subtype, neoadjuvant and adjuvant therapy (chemotherapy, HER2 immunotherapy, and Pembrolizumab) were collected. Complications included infection, hematoma, seroma, mastectomy flap necrosis, and implant removal for any reason. Major complications were defined as requiring readmission or return to the operating room. Variables were compared using Fisher Exact Tests and Wilcoxon Rank Sum Test. Results A total of 472 patients were analyzed. Twenty-seven (6%) patients received Pembrolizumab during their treatment. The median age of all patients was 46.7 years and median follow-up time was 12 months (interquartile range 7.0-19.0). One hundred and thirty-six (29.4%) underwent neoadjuvant chemotherapy and 423 (89.6%) reached their second stage of reconstruction and received implants. Seromas were significantly more likely during the expansion phase of reconstruction in patients who received pembrolizumab (44.4% vs 27%, p=0.049). All other complications and aggregate major complication rates were not statistically different in the expansion phase. Major complication rate after implant exchange was found to be significantly higher for patients who received Pembrolizumab (26.3% vs 8%, p=0.0194) leading to higher reoperation rates (19.1% vs 3.7%, p=0.0107).
Conclusion Pembrolizumab has emerged as a promising new therapy for TNBC in recent years, however its impact on surgical outcomes for two-stage prosthetic breast reconstruction is currently unknown. In our cohort, patients undergoing therapy incorporating Pembrolizumab experienced significantly higher rates of seroma following the first stage of reconstruction while major complications and reoperation were found to be significantly higher following implant exchange. These data may inform perioperative shared decision-making and further studies should be considered to define the impact of immunotherapy on outcomes following other types of breast reconstruction.

References 1. https://www.nejm.org/doi/full/10.1056/NEJMoa2202809 2. https://www.nejm.org/doi/full/10.1056/NEJMoa1910549 3. https://link.springer.com/article/10.1007/S00404-015-3859-Y 4. https://ascopubs.org/doi/abs/10.1200/JCO.2017.35.15_suppl.556 5. https://link.springer.com/article/10.1007/s12032-017-1071-6

Background: Autologous breast reconstruction (ABR) offers many benefits to patients when compared to implant based breast reconstruction (IBBR), including reduced need for maintenance or surveillance, use of the patient's own tissue, and ability to change size along with the patient's changes in weight. However post-operative recovery is substantially longer for ABR than IBBR; additionally, patients may have cultural or religious beliefs that influence their decision to pursue one type of breast reconstruction over another.

Project Aim: The aim of this project was to define demographic factors that may influence a patient's selection of the method of breast reconstruction.

Methods: All patients undergoing ABR at a tertiary care center in Atlanta, GA, from January 2016 to October 2024 were included in the study. Patients were called and surveyed regarding race, religion, political ideology, socioeconomic status, and social support. Data was analyzed in JMP.

Results: 82 patients consented to be a part of the study. The average age of participants was 50.6 years, the average BMI was 32.2, and 18.3% of patients had a diagnosis of diabetes mellitus. 47.6% underwent bilateral DIEP, 45.1% underwent unilateral DIEP, and 7.3% underwent another type of ABR.

46.3% of patients identified as Black, 6.1% identified as Hispanic, and 76.8% identified as non-Catholic Christian. 50% of patients identified their political ideology as neither Democrat nor Republican, 96.3% spoke English as their primary language, and 62.2% were married at the time of surgery. 50% of patients identified an undergraduate degree as the highest form of education they had obtained, 69.5% were employed at the time of surgery, and 46.3% had a household income of $100,000 or greater. 92.8% of patients had a primary care provider (PCP), 90.2% had discussed method of breast reconstruction with their oncologist prior to meeting with their plastic surgeon, and 64.6% knew that they were interested in receiving ABR prior to meeting with their plastic surgeon.

Conclusion: The majority of patients undergoing ABR at this institution showed evidence of strong social support and middle to high socioeconomic status. The majority were married, employed with high household income, already had a PCP, and practiced non-Catholic Christianity. Future studies should compare these demographic factors with those of patients undergoing IBBR in order to evaluate differences between the two groups.