Scientific Abstract Presentations: Breast Session 3 Thursday, October 15 Thu, Oct 15 5:00-6:00 p.m. CDT

Purpose: Adjunct lateral chest wall liposuction performed during reduction mammaplasty (RM) helps improve lateral contour and address residual bra-line fullness. However, the complication profile of RM when performed with concomitant lateral liposuction remains unclear. In addition, there is a paucity of literature on whether RM patients receiving adjunct liposuction benefit from closed-suction drain placement. Thus, the objectives of this study were to assess the effect of adjunct liposuction on outcomes following RM, and to evaluate whether closed-suction drain use mitigates complications associated with this combined approach.

Methods: A single-institution retrospective cohort study was conducted of patients who underwent primary, non-oncologic RM between January 2019 and December 2023. All patients had at least 90 days of follow-up. Throughout, (+L) denotes adjunct liposuction, (−L) denotes no liposuction, (+D) denotes drain placement, and (−D) denotes no drain. The pooled cohort (P) consisted of all RM patients who met inclusion criteria. P(+L) was compared to P(-L) to assess whether adjunct liposuction was independently associated with postoperative complications. P was then stratified into two subcohorts by pedicle technique: inferior pedicle (IP) and superomedial pedicle (SMP). IP and SMP patients were grouped by liposuction status and compared: IP(+L) vs IP(-L) and SMP(+L) vs SMP(-L). Then, both IP(+L) and SMP(+L) were subgrouped by drains status and compared: IP(+L)(+D) vs IP(+L)(-D) and SMP(+L)(+D) vs SMP(+L)(-D). Primary outcomes were 90-day postoperative complications, including T-point breakdown, seroma, nipple necrosis, hematoma, wound dehiscence, cellulitis, fat necrosis, and revision surgery. Stepwise multivariable logistic regression was used to evaluate associations, with Firth's penalized regression employed when events per variable were <5. Statistical significance was set at p<0.05.

Results: 1,042 patients met inclusion criteria and comprised the pooled cohort (P). Adjunct liposuction was independently associated with any complication (OR 1.86, 95% CI 1.19–2.92; p=0.007) and T-point breakdown (OR 3.09, 95% CI 1.11–8.19; p=0.032); however, IP was also an independent predictor of both outcomes. 394 patients were in the IP subcohort and 648 were in the SMP subcohort. In the IP subcohort, adjunct liposuction was associated with increased odds of any complication (OR 2.67, 95% CI 1.50–4.77; p=0.001) and T-point breakdown (OR 3.90, 95% CI 1.28–12.10; p=0.017), despite similar resection weights and lower BMI in IP(+L) than IP(-L). Among IP(+L), drain placement was protective against T-point breakdown (OR 0.05, 95% CI 0.002–0.60; p=0.014) and seroma (OR 0.14, 95% CI 0.01–0.93; p=0.042). In contrast, liposuction was not associated with increased complications in the SMP subcohort (OR 1.22, 95% CI 0.54–2.75; p=0.628). No seromas occurred in SMP(+L) regardless of drain status.

Conclusion: Adjunct liposuction increases postoperative complications in patients who undergo IP RM (but not in SMP RM), though use of closed-suction drains mitigates T-point breakdown and seroma in this population. These findings support the use of drains when liposuction accompanies IP RM, but not SMP RM, where routine drain omission remains safe regardless of adjunct liposuction use.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for diabetes management and weight optimization and are now commonly encountered among patients undergoing autologous breast reconstruction (1). While these agents may improve metabolic health and surgical candidacy, their effects on wound healing, fat metabolism, and reconstructive stability remain incompletely understood (2). To date, no study has specifically evaluated the association between perioperative GLP-1RA use and outcomes in autologous breast reconstruction. We hypothesize that GLP-1RA–mediated adipose remodeling may influence free flap volume stability.

Methods: A retrospective review was performed of patients undergoing autologous breast reconstruction at a single academic institution between 2022 and 2025. Patients were stratified based on perioperative GLP-1RA use and compared to nonusers. All patients had a minimum of eight months of postoperative follow-up. Primary outcomes included major and minor postoperative complications, including wound healing complications, fat necrosis, and flap-related events. Secondary outcomes included the need for secondary revision procedures. Demographic, clinical, and reconstructive variables were analyzed between groups.

Results: 115 patients met inclusion criteria, including 21 GLP-1RA users and 94 nonusers. Rates of flap loss, partial (0% vs 0%, p = 1) and complete (0% vs 2.1%, p = 1), were comparable between groups. No significant differences were observed in rates of delayed wound healing (28.6% vs 18.1%, p = 0.364), seroma (16.5% vs 19%, p = 0.748), superficial infection (14.3% vs 4.3% p = 0.113), deep infection (14.3% vs 9.6%, p = 0.457), hematoma (14.3% vs 9.6%, p = 0.457), or other complications. The rate of secondary revision procedures, including scar revision (28.6% vs 34%, p = 0.799) and fat grafting (28.6% vs 36.2%, p = 0.617), did not differ significantly between cohorts during the follow-up period.

Conclusions: Perioperative GLP-1RA use was not associated with increased major complications or higher rates of secondary revision following autologous breast reconstruction. Notably, despite the known effects of GLP-1RAs on systemic weight reduction and adipose tissue metabolism, patients receiving these agents were able to achieve satisfactory reconstructive outcomes without requiring significantly greater volumes of secondary fat grafting compared with nonusers. This suggests that GLP-1RA–associated fat loss does not meaningfully compromise flap durability, contour stability, or the ability to attain acceptable aesthetic results in autologous reconstruction. Collectively, these findings support the continued use of GLP-1RAs in appropriately selected patients and indicate that concerns regarding excessive postoperative volume loss or increased revision burden may be overstated. Further prospective studies with longer follow-up are warranted to better characterize the longitudinal effects of GLP-1RA–mediated metabolic changes on fat retention and aesthetic stability in autologous breast reconstruction.

References: 1. Ihnat JMH, De Baun H, Carrillo G, Dony A, Mukherjee TJ, Ayyala HS. A systematic review of the use of GLP-1 receptor agonists in surgery. Am J Surg. 2025;240:116119. doi:10.1016/j.amjsurg.2024.116119 2. Koenig ZA, Rashid S, Hobbs GR, Uygur HS. Perioperative GLP-1 Receptor Agonist Use & Surgical Outcomes in Non-bariatric Abdominal Panniculectomy: A 10-Year Retrospective Analysis. Plast Reconstr Surg. Published online August 26, 2025. doi:10.1097/PRS.0000000000012405

Introduction: Adolescent reduction mammaplasty remains debated due to concerns regarding benefit and complication risk, psychosocial and developmental factors, and insurance coverage challenges. While prior studies demonstrate symptom relief, the relationship between complication profiles and patient-reported outcomes in adolescents is incompletely defined. This study evaluates postoperative outcomes including complications and BREAST-Q scores to better characterize the risk-benefit profile of reduction mammaplasty in pediatric patients.

Methods: A retrospective cohort study was conducted of consecutive patients undergoing bilateral reduction mammaplasty at a single tertiary pediatric care center between 2018 and 2025 who completed pre- and postoperative BREAST-Q assessments. Demographics, operative variables, resection weights, follow-up duration, and complications were collected through chart review. Complications were categorized as major (requiring reoperation) or minor (managed nonoperatively). Hypertrophic scarring was recorded separately. Patients were stratified by BMI (≥30 vs <30 kg/m²) and resection weight (≥1000 g per breast vs <1000 g). Associations with complications were analyzed using chi-square testing with odds ratios (ORs) and 95% confidence intervals (CIs). Pre- and postoperative BREAST-Q Rasch scores were compared using paired t-tests, including subgroup analyses among patients with complications.

Results: A total of 130 patients underwent bilateral reduction mammoplasty and completed pre- and postoperative BREAST-Q questionnaires. Mean age was 17.4 ± 1.0 years (range, 15-20), and mean BMI was 28.6 ± 3.7 kg/m². Mean resection weight was 912.9 ± 369.0 g per breast (range, 272-2383). The mean follow-up duration was 23.1 ± 36.2 weeks (range, 0.6-276.1). Complications occurred in 22 patients (16.9%), including 5 major and 17 minor complications. Major complications included hematoma, infection, and fat necrosis. Minor complications were primarily wound dehiscence. Hypertrophic scarring was observed in 19 patients (14.6%); 7 underwent operative scar revision. On chi-square analysis, BMI ≥30 kg/m² (n=53) was not significantly associated with postoperative complications (OR 1.96, 95% CI 0.78–4.94; p=0.15). In contrast, resection weight ≥1000 g (n=49) was significantly associated with increased odds of complication (OR 4.66, 95% CI 1.74–12.49; p=0.001). Among patients completing the BREAST-Q Breast Satisfaction module (n=60), mean scores improved from 24.2 ± 13.4 preoperatively to 91.2 ± 10.1 postoperatively, representing a mean improvement of 67.1 points (95% CI 62.8–71.4; p<0.001). Patients with complications who completed the module (n=13) demonstrated comparable improvement (+67.2 points; p<0.001). Physical Well-Being scores (n=91) increased from 37.1 ± 11.6 to 84.8 ± 13.3 (+47.7 points, 95% CI 44.3–51.1; p<0.001), including patients with complications (n=15; +43.9 points; p<0.001). Psychosocial Well-Being scores (n=111) increased from 38.2 ± 17.5 to 86.7 ± 17.7 (+48.6 points, 95% CI 44.4–52.8; p<0.001), with continued significant improvement among those experiencing complications (n=20; +46.9 points; p<0.001).

Conclusion: Adolescents undergoing breast reduction experienced substantial and clinically meaningful improvements in satisfaction and well-being, with complication risk primarily associated with larger resections. These findings support the durability of patient-reported benefits following reduction mammaplasty in the pediatric population.

PURPOSE: Three-dimensional (3D) in vitro platforms offer powerful tools to study tumor cell behavior in physiologically relevant environments. Our laboratory previously developed a 3D biomimetic breast cancer platform demonstrating that matrix components alter tumor response to chemotherapy. Building on this work, we now apply a collagen-based 3D platform to investigate how estradiol (E2) influences proliferation and migration in both hormone receptor-positive (MCF-7) and triple-negative (MDA-MB-231) breast cancer cells, and how 3D matrix stiffness modulates these hormone-driven behaviors.

METHODS: MCF-7 and MDA-MB-231 cells expressing red fluorescent protein were exposed to graded E2 concentrations (0, 10⁻¹², 10⁻¹⁰, 10⁻⁸, 10⁻⁶, 10⁻⁴ M) in both 2D and 3D culture. In 2D, 2,000 cells were seeded per well and imaged using confocal fluorescent microscopy on Day 1 to establish baseline cell counts. Cells were cultured with E2-containing media and re-imaged on Day 5 to calculate normalized cell counts (Day 5 / Day 1). In 3D, 60,000 cells were embedded in ~50 µL constructs of 0.3% type I collagen, imaged on Day 1, and cultured in E2-containing media. On Day 10, cell counts and vertical migration were quantified using an Imaris™ machine-learning algorithm that reconstructed a regression plane and defined "migratory" cells as those located one standard deviation above or below the tumor layer's mean z-position. To assess matrix mechanics, additional cell-embedded 3D constructs were fabricated using 0.3% or 0.6% collagen and treated with either 10⁻⁶ or 0 M E2, with outcomes assessed on Day 10.

RESULTS: In 2D at 5 days, MCF-7 cells demonstrated a significant dose-dependent increase in normalized cell counts, peaking at 10⁻¹⁰ M E2 (p<0.001), whereas MDA-MB-231 exhibited stable proliferation across 0 to 10-6 M, with marked reduction at 10⁻⁴ M (p<0.001). In 3D at 10 days, MDA-MB-231 cells again maintained stable proliferation across low and intermediate doses with suppression at high doses (p<0.0001). In contrast, MCF-7 cells displayed a shifted dose-response in 3D, with maximal cell counts at 10⁻⁶ M E2 (p<0.001). Across all 3D E2 concentrations, no significant differences were observed in percentage of migratory cells or migration distance. Increased stiffness in 3D, resulting from higher collagen concentration (0.6%), suppressed cell counts (p<0.0001) and migration distance (p<0.0001) in MDA-MB-231 cells independent of E2 exposure. Meanwhile in MCF-7 cells, E2-associated increases in cell counts were most pronounced in softer 0.3% collagen and attenuated in stiffer collagen (p<0.05), without stiffness-dependent differences in migration.

CONCLUSIONS: MDA-MB-231 cells, lacking estrogen receptor (ER) expression, show minimal response to E2 in both 2D and 3D formats, with suppression at high doses likely reflecting cytotoxicity. In contrast, ER-positive MCF-7 cells demonstrate hormone-dependent proliferation, with the E2 concentration required for maximal response increasing in 3D matrices, suggesting potentially dampened hormone responsiveness in 3D environments. Matrix stiffening differentially constrains tumor behavior based on receptor status, broadly suppressing triple-negative cells, while limiting E2-associated proliferation in ER-positive cells without altering migration. These findings highlight the importance of dimensionality and matrix mechanics in shaping hormone-driven behaviors and support continued development of 3D culture models to better reflect in vivo breast cancer biology.

INTRODUCTION Glucagon-like peptide-1 (GLP-1) receptor agonists are widely used for weight loss and glycemic control, with increasing use among patients undergoing elective and reconstructive procedures. Although these agents provide metabolic benefits, their effects on perioperative outcomes remain poorly defined, particularly regarding wound healing, tissue perfusion, and reconstructive outcomes. Recent studies suggest that GLP-1 agonists may influence nutritional status and tissue viability, potentially affecting surgical healing.

Implant breast reconstruction depends on adequate tissue perfusion and wound healing, and factors that impair these processes may increase complication and revision rates and affect aesthetic outcomes. However, the impact of GLP-1 agonist use on reconstructive outcomes in this population remains unclear. This study evaluates the association between GLP-1 agonist use and postoperative complication and revision rates in patients undergoing two-stage expander-implant breast reconstruction.

METHODS A retrospective chart review was conducted at a single institution of patients who underwent immediate two-stage expander-implant breast reconstruction between 2017 and 2022. Patients with documented perioperative use of GLP-1 receptor agonists were identified and compared with patients who did not use GLP-1 agonists during the same period.

Demographic characteristics, comorbidities, operative variables, and postoperative outcomes were collected. Primary outcomes included postoperative complications and revision procedures. Complications included capsular contracture, infection, hematoma, implant malposition, and other adverse events. Revision procedures performed through the most recent follow-up were documented.

Bivariate analyses included Chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables. Multivariate logistic regression evaluated the independent association of GLP-1 agonist use with complications and revision surgery, adjusting for age, obesity (BMI ≥30), hypertension, diabetes, and tobacco use.

RESULTS A total of 278 patients were included, comprising 48 patients in the GLP-1 agonist group and 230 controls. Baseline demographics and comorbidities including BMI, radiation, chemotherapy, diabetes, hypertension, and tobacco use were similar between groups. The overall cohort had a mean age of 50.29 years and mean BMI of 25.02 kg/m², with 76 patients undergoing unilateral and 202 bilateral reconstructions.

The postoperative complication rate was 20.8% in the GLP-1 group compared with 6.5% in controls (p=0.002). Revision surgery was required in 50.0% of GLP-1 patients versus 34.3% of controls (p=0.041), with a mean of 1.13 revisions per patient in the GLP-1 cohort compared with 0.48 in controls (p=0.006). Among patients requiring at least one revision, GLP-1 users underwent more procedures (2.25 vs 1.39, p=0.003).

On multivariate logistic regression controlling for age, obesity, diabetes, hypertension, and tobacco use, GLP-1 agonist use was associated with significantly increased odds of postoperative complications (aOR 4.60, 95% CI 1.80–11.75, p=0.001) and revision surgery (aOR 2.10, 95% CI 1.08–4.10, p=0.030).

CONCLUSION Perioperative GLP-1 receptor agonist use is independently associated with significantly increased rates of postoperative complications and revision surgery in patients undergoing two-stage expander-implant breast reconstruction. These associations persisted after adjusting for metabolic comorbidities and patient characteristics. These findings highlight a potential modifiable perioperative risk factor and underscore the importance of preoperative patient counseling. Prospective studies are needed to better understand the mechanisms of these associations and establish evidence-based perioperative management.

Background: Deep inferior epigastric perforator (DIEP) flap breast reconstruction is associated with high long-term patient satisfaction; however, the recovery process is prolonged and complex. Limited data exist regarding patient perceptions of perioperative education, particularly which informational gaps persist after discharge and how these gaps influence confidence and postoperative healthcare utilization. The purpose of this study was to identify gaps in perioperative education following DIEP flap breast reconstruction and assess their relationship with patient confidence and postoperative healthcare utilization. Methods: A cross-sectional survey was administered to patients who underwent DIEP flap breast reconstruction at a single academic institution. The survey incorporated the BREAST-Q Information Satisfaction module and additional items assessing postoperative confidence, unanswered questions after discharge, and communication preferences. Clinical variables and 30-day healthcare utilization outcomes (e.g., emergency department (ED) presentation, hospital readmission) were abstracted from the medical record. Associations between BREAST-Q scores, patient factors, and healthcare utilization were analyzed using nonparametric tests, multivariable linear regression, and logistic regression. Statistical significance was set to p<0.05. Results: Eighty-one of 224 patients (36%) completed the survey; respondents more frequently underwent bilateral reconstruction compared with non-responders (80% vs 66%, p=0.03). Nearly half of respondents (48%) reported unanswered questions after discharge, most commonly regarding wound expectations (57%), pain issues (31%), and activity restrictions (20%). The overall BREAST-Q Information Satisfaction score was 66.6 ± 21.0 (median 64, IQR 51–85). Individual item scores showed opportunities for improvement clustered around recovery expectations, specifically time to feel normal again (mean 2.9 ± 1.1; 34% dissatisfied), other women's experiences with reconstruction (mean 2.9 ± 1.0; 34% dissatisfied), scar appearance (mean 2.9 ± 1.1; 32% dissatisfied), and lack of sensation in reconstructed breasts (mean 3.0 ± 1.0; 28% dissatisfied). Lower BREAST-Q Information scores were associated with clinical and psychosocial factors. Patients with obstructive sleep apnea had lower scores than those without OSA (54.9 ± 20.6 vs 70.5 ± 19.8; p=0.002), remaining significant on multivariable analysis (β=−15.9, p=0.006). Depression was independently associated with lower scores (β=−7.9, p=0.03). Unanswered questions had a strong negative correlation with BREAST-Q scores (ρ=−0.67, p<0.001), while discharge confidence showed a strong positive correlation (ρ=0.65, p<0.001). Patients reporting many unanswered questions had higher incidence of ED visits (43% vs 19%) and readmission rates (36% vs 12%), with increased odds of ED visits (OR 3.44, 95% CI 1.01–11.75; p=0.04) and readmissions (OR 4.76, 95% CI 1.24–18.27; p=0.02). Each one-point increase in discharge confidence was associated with a 64% reduction in readmission odds (OR 0.36, 95% CI 0.15–0.88; p=0.02). Conclusion: Despite high overall satisfaction with perioperative education, nearly half of DIEP flap patients reported unanswered questions after discharge, with lowest satisfaction centered on recovery expectations and experiential outcomes rather than technical surgical information. Lower satisfaction was strongly associated with decreased confidence and increased emergency department utilization and readmissions. These findings highlight the need for targeted, recovery-focused educational interventions to better prepare patients for postoperative recovery and potentially reduce downstream healthcare utilization following DIEP flap breast reconstruction.

Background: Oncoplastic reduction mammaplasty is becoming an increasingly popular option for patients who pursue breast conservation as it allows for both improved aesthetic and oncologic outcomes. Previous meta-analyses reveal that re-excision occurs in a minority of patients, and a majority are due to invasive lobular carcinomas. However, no report has directly compared the re-excision rates of in-situ versus invasive cancer within the same cohort, nor deduced the impact of cancer stage, grade, and size on re-excision rates.

Methods: A retrospective review of patients who underwent oncoplastic reduction mammoplasty between 2020-2024 at a single academic institution was conducted. Patients who had a re-excision due to positive margins were compared to patients who did not undergo re-excision across degree of invasion (in situ vs invasive), cancer stage, histological grade, and initial lumpectomy volume. Patients with a diagnosis of ductal carcinoma in-situ (DCIS), lobular carcinoma in-situ (LCIS), invasive ductal carcinoma (IDC), or invasive lobular carcinoma (ILC) were included.

Bivariate analyses were performed using chi square, Mann-Whitney, and independent t-tests. Multivariable logistic regression models were constructed and included clinically relevant covariates to assess potential independent predictors of re-excision. Secondary analyses examined re-excision rates in patients diagnosed with ILC exclusively. Stata 18.0 was used for all statistical analyses.

Results: Of the 410 patients identified, 54 patients (13%) underwent re-excision while 356 patients (87%) did not. Cohorts differed significantly in age (p=0.0204), race (p=0.006), invasive disease grade (p=0.008), and receipt of adjuvant radiation (p=0.047). Lumpectomy volume (p=0.0876) and invasive histology (p=0.1) each approached significance and therefore were included in multivariable analyses. Undergoing a re-excision was not associated with postoperative complications (all p>.05). Of those who underwent re-excision, 29 patients (54%) underwent simple re-excision, while 30 patients (56%) underwent mastectomy. On multivariable logistic regression, age was inversely associated with re-excision (OR: 0.96; CI: .93-.99; p=0.041), while Asian race (OR: 6.01; CI: 2.03-17.77; p=0.001) and ILC histology (OR: 2.54; CI: 1.07-6.06; p=0.035) were independently associated with increased rates of re-excision.

Within the ILC patient population sub-analysis, 12 patients (20%) underwent re-excision, while 49 patients (80%) did not. Patients who underwent re-excision had significantly lower BMI (p=0.0306) and were more likely to have received neoadjuvant chemotherapy (p=0.003). Preoperative bra size, incision or pedicle, tumor grade, lumpectomy volume, and complication rates were comparable between groups. On multivariable logistic regression, receipt of neoadjuvant chemotherapy was found to be an independent predictor for re-excision for ILC patients.

Conclusion: This is the most comprehensive report on re-excision rates and associated risk factors to date in breast conservation patients at a single institution. Our data suggests that younger age, Asian race, and ILC histology are independent predictors of undergoing re-excision after oncoplastic reduction mammoplasty. ILC focused analysis also identified receipt of neoadjuvant therapy as an independent predictor of re-excision within this subpopulation. Future analyses will focus on determining the impact of receptor status as a conduit of cancer aggression on re-excision rates.

Introduction: Sensory loss following mastectomy and breast reconstruction remains a common patient concern, yet high-quality prospective data describing early sensory recovery and its relationship to patient-reported outcomes are limited. This study evaluates early objective sensory changes and patient-reported outcomes following unilateral prepectoral implant-based breast reconstruction using a self-controlled design.

Methods: This prospective, single-center, single-surgeon cohort study enrolled patients undergoing primary unilateral mastectomy with immediate prepectoral implant-based reconstruction beginning July 2024. Patients with prior breast surgery, radiation therapy, BRCA mutation, or refusal to participate were excluded. Objective sensory testing included Semmes-Weinstein monofilaments, two-point discrimination, and pain sensation assessed across standardized breast zones. Assessments were performed preoperatively and postoperatively at 3 and 6 months. Patient-reported outcomes were collected using the BREAST-Q. The contralateral breast served as an internal control. Paired and unpaired t-tests and correlation analyses were performed, with statistical significance set at p<0.05. Institutional ethics approval and informed consent were obtained.

Results: Of 257 patients screened, 43 met eligibility criteria and completed baseline testing. Fourteen patients completed postoperative sensory assessments at 3 months (n=10) or 6 months (n=4). Mean age was 52.7 years (SD 11.2) and mean BMI was 26.8 (SD 5.7). Mean mastectomy weight was 452 g (range 142–1306 g). Reconstruction included tissue expanders in 10 patients and direct-to-implant reconstruction in 4 patients. Mastectomy type included nipple-sparing (n=6) and skin-sparing (n=8). At baseline, the operative breast demonstrated significantly reduced sensation compared with the contralateral breast (p=0.03). Greater mastectomy weight and tumor size were associated with diminished baseline sensation (p<0.02 and p=0.01, respectively). Higher BMI and larger breast dimensions were associated with decreased baseline two-point discrimination and soft-touch sensation (p<0.05). Soft-touch sensation declined significantly from baseline to 3 months (mean score 4.6 vs 2.4, p<0.001), with partial recovery by 6 months and no significant difference from baseline (4.6 vs 4.3, p=0.13). Two-point discrimination similarly declined at 3 months (4.7 vs 2.8, p=0.01) with significant improvement between 3 and 6 months (2.2 vs 4.0, p=0.01). Pain sensation demonstrated the greatest early decline at 3 months (3.0 vs 2.2, p=0.006) and showed slower recovery over time. BREAST-Q sensation scores decreased significantly at 6 weeks postoperatively (7.5 vs 5.9, p=0.004) but normalized by 3 months and remained stable at 6 months. No significant changes were observed in other BREAST-Q domains. Older age was associated with higher baseline BREAST-Q scores (p=0.028), and greater mastectomy weight correlated with higher sensation scores at 3 months (p=0.033).

Conclusions: Unilateral prepectoral implant-based breast reconstruction is associated with an early decline in objective breast sensation, followed by measurable recovery beginning within the first 3 months postoperatively. Sensory recovery parallels stabilization of patient-reported outcomes, suggesting early perceptual adaptation despite transient objective deficits. Baseline sensation is influenced by anatomical and patient-specific factors, highlighting their importance in preoperative counseling. Ongoing follow-up will further define long-term sensory recovery trajectories.

Background: Immediate breast reconstruction (BR) following mastectomy is an integral component of multidisciplinary breast cancer care and has well established aesthetic and psychosocial benefits. Despite its advantages, concern persists that reconstruction may delay initiation of adjuvant therapy, particularly radiation, and potentially compromise oncologic outcomes. While small delays have been reported, their clinical relevance remains uncertain (1). This study evaluates whether immediate BR influences timing of adjuvant therapy and locoregional recurrence-free survival (LRFS) following mastectomy. Methods: We conducted a retrospective cohort study of patients with invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC) who underwent mastectomy at a single academic institution between 2010 and 2023. Patients were stratified by receipt of immediate reconstruction. Demographic and oncologic variables were collected. Primary outcomes included time to initiation of adjuvant chemotherapy and radiation therapy. Secondary outcomes included LRFS. Subgroup analyses were performed among patients receiving radiation therapy and according to reconstruction modality, including implant-based and autologous techniques. Statistical analyses included ANOVA for continuous variables, Kaplan-Meier survival analysis, and multivariable Cox proportional hazards modeling to evaluate predictors of LRFS. Results: A total of 802 patients met inclusion criteria, including 352 (43.9%) who underwent BR and 450 (56.1%) who did not. Among reconstructed patients, 65% underwent implant-based reconstruction and 35% underwent autologous reconstruction. Patients undergoing BR experienced a statistically significant 15-day delay in initiation of adjuvant radiation compared to those without reconstruction (115.1 vs. 100.4 days, p=0.032). There was no significant delay in time to initiation of adjuvant chemotherapy between groups. Kaplan-Meier analysis demonstrated no significant difference in LRFS between reconstruction and non-reconstruction cohorts over 2.5 years of follow-up (p=0.11). In the radiation subgroup (n=231), time to radiation initiation was not associated with worsened LRFS (OR 1.011, 95% CI 0.998-1.023), indicating that incremental delays did not meaningfully affect recurrence risk. Additionally, LRFS did not differ significantly between implant-based and autologous reconstruction modalities (p=0.20). Across analyses, reconstruction status and reconstruction type were not independent predictors of locoregional recurrence. Conclusion: Immediate breast reconstruction following mastectomy is associated with a modest delay in initiation of adjuvant radiation therapy; however, this delay does not translate into worse locoregional recurrence-free survival. No differences in survival outcomes were observed between reconstruction and non-reconstruction patients or among reconstruction modalities. These findings support the oncologic safety of immediate reconstruction and suggest that modest delays in radiation initiation are not clinically significant. Further studies with longer follow-up and multicenter validation are warranted to confirm these findings and strengthen generalizability. References: 1. Vandergrift JL, Niland JC, Theriault RL, et al. Time to Adjuvant Chemotherapy for Breast Cancer in National Comprehensive Cancer Network Institutions. JNCI J Natl Cancer Inst.

Background: Breast reconstruction following mastectomy can be performed using implant-based techniques or autologous tissue transfer. Implant-based reconstruction typically involves shorter operative times and reduced donor-site morbidity, whereas autologous reconstruction requires longer operative duration and microvascular anastomosis, potentially impacting postoperative recovery. In breast cancer patients, initiation of adjuvant chemotherapy more than 91 days after surgery has been associated with worse survival (1). This study compares initiation of adjuvant chemotherapy within 30 and 60 days between patients undergoing implant-based versus autologous breast reconstruction. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including adult female patients with invasive breast cancer who underwent mastectomy followed by either implant-based reconstruction (tissue expander or direct-to-implant) or autologous reconstruction (free flap, TRAM, DIEP, latissimus dorsi). Propensity score matching was performed to balance baseline characteristics, including age, race, BMI, hypertension, diabetes, tobacco use, cardiovascular disease, nodal involvement, metastatic disease, and personal history of breast cancer. The primary outcome was initiation of chemotherapy within 30 and 60 days following reconstruction. Patients with chemotherapy exposure prior to the index procedure were excluded from risk and survival analyses. Risk differences, risk ratios, odds ratios, Kaplan–Meier analysis, and Cox proportional hazards modeling were applied. Results: After propensity score matching, 3,054 patients in each cohort were analyzed. Within 30 days postoperatively, chemotherapy was initiated in 2.1% of implant-based patients compared with 0.8% of autologous patients (risk difference 1.3%; 95% CI 0.6%–2.0%; p < 0.001). Implant-based reconstruction was associated with increased likelihood of early chemotherapy initiation (RR 2.64; OR 2.67). Kaplan–Meier analysis demonstrated lower therapy-free survival at 30 days in the implant cohort (97.85% vs 99.19%; log-rank p < 0.001), with a hazard ratio of 2.67 (95% CI 1.58–4.53). Within 60 days, chemotherapy was initiated in 10.5% of implant-based patients compared with 8.4% of autologous patients (risk difference 2.1%; 95% CI 0.4%–3.7%; p = 0.014). Implant-based reconstruction remained associated with higher likelihood of chemotherapy initiation (RR 1.25; OR 1.28). Kaplan–Meier analysis demonstrated reduced therapy-free survival at 60 days in the implant cohort (89.3% vs 91.5%; log-rank p = 0.006), with a hazard ratio of 1.29 (95% CI 1.08–1.56). Mean number of chemotherapy instances was also higher in the implant group at both time intervals (p < 0.01). Conclusion: Compared with autologous reconstruction, implant-based reconstruction was associated with earlier initiation of adjuvant chemotherapy within both 30-day and 60-day postoperative windows. Although the absolute differences were modest, consistent findings across analytic approaches suggest reconstruction modality may influence the timing of systemic therapy initiation. For most patients, both reconstruction options allow timely chemotherapy, though implant-based reconstruction may facilitate slightly earlier treatment initiation. Further investigation is warranted to evaluate long-term oncologic outcomes, including recurrence and survival, as well as patient-reported quality-of-life measures. These findings also underscore the importance of careful patient selection and multidisciplinary coordination when considering autologous versus implant-based reconstruction. 1. Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH. Delayed Initiation of Adjuvant Chemotherapy Among Patients With Breast Cancer. JAMA Oncol. 2016;2(3):322-329. doi:10.1001/jamaoncol.2015.3856