Scientific Abstract Presentations: Breast Session 7 Saturday, October 17 Sat, Oct 17 8:00-9:30 a.m. CDT

Background Incongruence between post mammaplasty nipple sensation reports and anatomical descriptions of nipple sensation creates a suspicious void in literature. Superomedial (SM) based pedicles have gained interest over the last decade; however, this surgery does not align with practiced sources of nipple sensation nor ability to breast feed postoperatively (1). To address this gap, this study compared the preservation and pattern of nipple sensation between the Central Mound (CM) and SM pedicle. Methods A retrospective cohort study was conducted via survey with 51 respondents with history of CM or SM pedicle reduction mammaplasty. All respondents had their surgery done from May 2020 to May 2025 with at least 6 months of follow-up. Demographics included age, BMI, diabetes, hypertension, smoking status, and OR time. General and erogenous nipple sensitivity were scored on a 5-point Likert scale (1=no sensation, 3=normal, 5=hypersensitivity) across four timepoints: preoperative, 2 weeks postoperative, 3 months postoperative, and present day. The average absolute value of Likert point changes was calculated between each timepoint. Data regarding present-day sensitivity, recovery patterns after the initial 2 week recovery period, and complications were also compared. Results The CM (n=29) and SM (n=22) cohorts were similar in age (CM: 38.1 vs 42.1), BMI (28.1 vs 29.0), and comorbidities (p>0.1). The SM cohort had greater resection weights (1,243.73g vs. 881.36g, p=0.025) and longer OR time (139.36 min vs. 107.21 min, p=0.008). General nipple sensitivity in the SM cohort experienced greater sensory changes at all time points, though only 2 weeks postop was statistically significant (|1.31| vs |2.09|, p=0.0120), and a higher incidence of present-day sensory loss (59% vs. 28%, p=0.0432). Erogenous sensitivity was significantly better preserved in the CM cohort at all timepoints (2 week: |1.07| vs |2.19|, 3 months: |1.00| vs |2.19|, present day: |1.00| vs |1.81|). 52% of CM patients reported normal present day erogenous sensation compared to 9% of SM patients (p=0.0022), while sensory loss was significantly more prevalent in the SM group (59% vs. 21%, p=0.0082). Both cohorts described a consistent, unchanging nipple sensitivity after the 2 week postop period for general and erogenous sensation in most respondents (CM: 55%, SM: 41%). Increasing sensitivity over time and fluctuating sensitivity were the second and third most common patterns, respectively. More complications were noted in the SM cohort (2 infections, 4 delayed nipple healing) vs the CM cohort (2 delayed healing, 1 hematoma) although complication rates (CM 10% vs. SM 27%, p=0.11) were not significant. Conclusion Thes findings suggest the CM pedicle demonstrates greater preservation of nipple sensitivity than the SM pedicle, particularly in the immediate postop period. Interestingly, most patients displayed consistent sensitivity after this period. Nipple sensitivity translates to improved patient outcomes in terms of sexual well-being and confidence. Given these potential benefits, future studies should be conducted with different methods of assessing sensitivity while clarifying breast feeding ability across different techniques.

References: 1. Tanas Y, Tanas J. Comparative Outcomes of Superomedial and Inferior Pedicles in Breast Reduction and Mastopexy: A Meta-Analysis of 5123 Breasts. Aesthetic Plast Surg. 2025;49(5):1327-1339. doi:10.1007/s00266-024-04389-0

Background:

Flap-based breast reconstruction carries higher risks and postoperative complications compared to implants.1 Few large-scale data exist that examine predictors of surgical outcomes across a diverse and nationally generalizable cohort. This study aims to evaluate outcomes following flap-based breast reconstruction using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Breast Reconstruction Pilot dataset.

Methods:

A retrospective analysis of flap-based breast reconstruction was performed using the ACS NSQIP database, including patients treated between July 2024 and August 2025 at participating centers. Cases were identified using the "Breast Reconstruction Type" variable indicating use of autologous tissue. Demographics, oncologic and reconstructive characteristics, and 30-day outcomes were collected. Predictors included reconstruction timing (immediate vs. delayed), prior surgery, radiation history, and steroid use. Outcomes included hematoma, seroma, mastectomy skin flap necrosis, partial flap failure (vascular complications requiring wound care; vascular complications requiring Return to Operating Room [RTOR] with salvage or partial removal), total flap failure (requiring RTOR with complete removal), surgical site infection (SSI), unplanned readmission, and RTOR. Complications were recorded per patient and counted if present in either breast for bilateral cases. Univariate analyses were performed using Chi-square, Fisher's exact, t-tests, or nonparametric tests as appropriate.

Of 5,870 identified cases across 49 centers, exclusions for incomplete data, urgent/emergent status, unrelated primary CPT codes (19325, 19370, 19371, 19380), or non–flap-based coding yielded 1,271 patients (2,123 breasts) across 39 centers meeting inclusion criteria.

Results:

A total of 1,271 patients from 39 institutions met the inclusion criteria. Postoperative complications included partial flap failure (vascular complications) in 58 patients (4.6%) and total flap failure in 14 patients (1.1%). Disseminated cancer was the strongest predictor for both partial flap failure (OR 6.34; 95% CI, 2.02–19.92; p < 0.01) and unplanned RTOR (OR 3.85; 95% CI, 1.35–10.98; p < 0.05). Increased BMI was significantly associated with partial flap failure (OR 1.07; 95% CI, 1.01–1.12); p < 0.05), SSI (OR 1.08CI 95%), and unplanned readmission (OR 1.08, CI 95%). Diabetes mellitus and smoking status were also independent risk factors for any SSI (OR 1.78, p < 0.05 and OR 2.43, p < 0.05, respectively) and unplanned readmission (OR 2.54, p < 0.01 and OR 2.52, p < 0.05, respectively). No significant associations were found between these comorbidities and total flap failure, likely due to the low overall incidence of total loss.

Conclusion

This study of 1,271 patients-representing one of the largest datasets to date characterizing autologous outcomes-establishes a baseline rate for total (1.1%) flap failure. While systemic comorbidities drive infectious complications and readmissions, advanced oncologic stage serves as the primary predictor of partial flap loss. This benchmarked failure rate provides essential data for preoperative patient counseling and emphasizes the need for specialized perioperative management in patients with disseminated disease.

References 1. Bennett KG, Qi J, Kim HM, Hamill JB, Pusic AL, Wilkins EG. Comparison of 2-Year Complication Rates Among Common Techniques for Postmastectomy Breast Reconstruction. JAMA Surg. 2018;153(10):901-908. doi:10.1001/jamasurg.2018.1687

Purpose: Autologous fat grafting (AFG) is frequently used for secondary aesthetic refinement following mastectomy and breast reconstruction. Although fat grafting is thought to stabilize at three months, the longitudinal stability of fat graft retention within reconstructed tissue beds remains incompletely characterized. We evaluated whether volumetric retention demonstrates progressive decline over time and whether repeat grafting reflects inadequate retention after the index procedure.

Methods: Patients undergoing fat grafting following mastectomy and breast reconstruction between January 2021 and March 2025 were included. Percent volume retention was quantified using standardized three-dimensional imaging. Follow-up was calculated from the date of each grafting procedure to volumetric assessment using actual operative and imaging dates. Retention measurements were categorized as 0–3 months (≤104 days), 3–6 months (105–180 days), and >6 months (>180 days). For patients undergoing repeat grafting, retention for each episode was calculated relative to the corresponding procedure and included as longitudinal observations. Mixed-effects linear regression with random intercepts for patients was used to evaluate differences in retention across time intervals. A subanalysis compared retention after the index grafting procedure between patients who subsequently underwent repeat grafting and those who did not.

Results: Sixty longitudinal retention measurements from 43 unique patients were analyzed, including 7 patients who underwent repeat grafting. Median follow-up was 116.5 days (IQR 98.5–170.3), extending to 756 days from the index fat grafting procedure. Distribution across time intervals was: 0–3 months (n=32), 3–6 months (n=17), and >6 months (n=11). In mixed-effects modeling, retention did not differ significantly between 0–3 and 3–6 months or between 0–3 and >6 months. No significant decline in retention was observed across follow-up intervals. Retention after the index procedure did not differ between patients who later underwent repeat grafting and those who did not (p = 0.52).

Conclusion: In patients undergoing fat grafting for post-mastectomy breast reconstruction refinement, volumetric retention did not significantly decline over time. Retention after the index procedure did not differ between patients who later underwent repeat grafting and those who did not. These findings support the three-month interval as an appropriate endpoint for longitudinal volumetric assessment in reconstructed breasts.

PURPOSE: Considering increasing antibiotic resistance and stewardship recommendations favoring targeted therapy, polymethylmethacrylate-based antibiotic (PMMA) discs attempt to provide infection prophylaxis and minimize antibiotic burden via local action. Although PMMA discs are commonly used in other surgical fields, they have yet to be widely adopted in breast reconstruction but are emerging as promising tool to reduce surgical site infection in prepectoral tissue expander (TE) based reconstruction. This study aims to evaluate their efficacy in preventing adverse infection-related outcomes among patients undergoing two-stage prepectoral breast reconstruction.

METHODS: A retrospective review was conducted of all patients at a single institution who underwent immediate two-stage prepectoral reconstruction at a single center between January 2018 and October 2024 with ≥3 months of follow-up. Exclusion criteria included autologous, delayed, or direct-to-implant reconstructions, and chemotherapy after implant exchange. Major complications were defined as those requiring readmission or reoperation. Statistical analyses were performed using Fisher's Exact and Wilcoxon Rank Sum tests.

RESULTS: Among 459 patients at one institution, 44 underwent reconstruction with PMMA disc placement. Discs were placed more often in bilateral cases (p=0.0118). Median follow-up was shorter in the PMMA discs group than in the no-spacer group (p < .0001). For patients treated at our institution, while a higher rate of seroma was observed among those receiving PMMA discs (p < .0001), major complications (p = 0.0493), major infections (p=0.0376), minor infections (p=0.0370), and necrosis (p=0.0161) were significantly less frequent following PMMA disc placement.

CONCLUSION: Postoperative infection remains an important clinical challenge in breast reconstruction. At our institution, PMMA disc usage is associated with reduced rates of some infection-related complications in two-stage prepectoral breast reconstruction.

Purpose:
Revision procedures following post-mastectomy reconstruction are common (~40%), yet comparative studies often have ≤2 years of follow-up, frequently combine direct-to-implant (DTI) and tissue expander (TE)/implant reconstructive pathways, and often lack external validity due to reliance on local institutional data, limiting patient counseling on long-term expectations.(1, 2) This study examined 5-year revision rates following post-mastectomy immediate reconstruction across two-stage implant-based reconstruction (IBBR), autologous breast reconstruction (ABR), and DTI and identified patient factors associated with revision occurrence using a federated health records network.

Methods: A global retrospective study was performed. Adults undergoing mastectomy with same-day ABR, DTI, or TE with delayed implant exchange were queried using procedural codes and time-linking events via a federated EHR network comprising 171 healthcare organizations. Outcomes from 3 months to 5 years postoperatively included breast revision and related refinement procedures. Cox regression (3mo–5yr) identified predictors of breast revision procedures; significant covariates informed propensity-score-matching between cohorts. Outcomes were compared between cohort pairs.

Results: A total of 33,911 patients were identified: ABR n=11,246, two-stage IBBR n=12,702, and DTI n=9,963. In Cox models, obesity, breast malignancy, depression, and anxiety were associated with higher revision hazard (all p<0.001); older age, diabetes, and nicotine dependence were associated with lower hazard (p≤0.044). After matching, two-stage vs ABR included 9,415 patients per cohort, and two-stage vs DTI included 9,045 per cohort. Two-stage IBBR had the highest 5-year revision risk compared with ABR (RR 1.21, 95% CI 1.16–1.26) and DTI (1.98, 1.88–2.10). Revisions were most frequent between >3mo and ≤1yr (two-stage: 21.2%, ABR: 18.6%, and DTI: 9.6%), less frequent between >1 and ≤3yr (14.3%, 11.3%, 7.3%), and least frequent between >3 and ≤5yr (3.2%, 2.5%, and 1.7%). By 5 years, asymmetry diagnoses were most common after two-stage (29.7% vs 20.5% ABR vs 15.5% DTI). The mean number of revisions after two-stage (1.35±0.70) was higher than DTI (1.28±0.66; p=0.003) and comparable to ABR (1.37±0.76, p=0.171). Two-stage also had higher rates of reduction and augmentation procedures than ABR or DTI (all p<0.001). In contrast, the mean number of fat grafting procedures was lowest after two-stage (1.09±0.32) compared to DTI (1.27±0.53, p=0.005) or ABR (1.28±0.72, p=0.009).

Conclusions: Five-year postoperative revisions were independently associated with reconstructive procedure, age, BMI, and clinical and psychiatric comorbidities. Over five years, the risk of revision differed by reconstructive pathway: two-stage IBBR had a 20% higher risk than ABR and a 98% higher risk than DTI, with most revisions occurring during the first postoperative year. Although DTI had the lowest revision risk, revisions still occurred in ~1 in 6 patients. Therefore, these pathway-specific estimates may help guide counseling that distinguishes TE/implant, ABR, and DTI expectations, and may warrant brief attention to baseline anxiety/depression given their association with higher revision hazard.

References: 1. Nelson JA, Voineskos SH, Qi J, et al. Elective Revisions after Breast Reconstruction: Results from the Mastectomy Reconstruction Outcomes Consortium. Plast Reconstr Surg. 2019;144(6):1280-90. 2. Bennett KG, Qi J, Kim HM, et al. Comparison of 2-Year Complication Rates Among Common Techniques for Postmastectomy Breast Reconstruction. JAMA Surg. 2018;153(10):901-8.

Purpose: Intraoperative hypotension during breast reconstruction procedures can be managed by vasopressor administration, intravenous fluid administration, or both; however, many plastic surgeons are hesitant to utilize vasopressors due to the perceived risk of microvascular complications (1). The impact of vasopressor use on intraoperative and postoperative autologous free flap breast reconstruction complications has yet to be fully elucidated. This study evaluates the independent effects of vasopressor use, timing of vasopressor administration within vasopressor type subgroups, and total vasopressor dosage on intraoperative and postoperative complications among patients undergoing abdominally based autologous free flap breast reconstruction.

Methods: We conducted a retrospective study of 453 patients (745 breasts) who underwent abdominally based autologous free flap breast reconstruction at a single academic center between September 2012 and December 2024. Demographics, surgical variables, and intraoperative and postoperative complications at the breast site were collected, including both vascular and non-vascular complications. Vasopressor-specific variables included intraoperative administration status, agent type, timing relative to induction, and total administered dose. Vasopressors included ephedrine, phenylephrine, and norepinephrine. Timing was categorized as peri-induction (±30 minutes from anesthesia induction), post-induction (>30 minutes after induction), or both. Baseline characteristics and group balance were assessed using standardized mean difference (SMD). Complications were compared using chi-square or Fisher's exact tests, with Bonferroni correction for multiple comparisons to control for type I error. Dosage effects were evaluated using univariate logistic regression.

Results: Among 745 breasts, 611 (82.0%) received any vasopressor and 134 (18.0%) received fluids only. Complication rates did not differ between breasts exposed to vasopressor and those managed with fluids alone. Baseline characteristics were well balanced between these two groups (SMD<0.2) with the exception of age, which demonstrated moderate imbalance (SMD=0.394). Timing of vasopressor administration (peri-induction only, post-induction only, or both) was examined within agent-specific subgroups (ephedrine alone, phenylephrine alone, norepinephrine alone, or combination therapy). Across all vasopressor subgroups, timing was not associated with differences in individual vascular and non-vascular complications, nor with composite overall or vascular complication outcomes. Among patients receiving a single vasopressor agent, total cumulative dose was not associated with risk of individual or composite complications, including overall and vascular complication outcomes.

Conclusions: Vasopressor exposure was not associated with increased risk of vascular or non-vascular intraoperative or postoperative breast complications across agent types, timing categories, or cumulative dosing. These findings suggest that vasopressor use for intraoperative hemodynamic management during autologous abdominally based free flap breast reconstruction is generally well tolerated.

References: 1. Vyas K, Wong L. Intraoperative Management of Free Flaps: Current Practice. Ann Plast Surg. 2014;72(6):S220. doi:10.1097/SAP.0000000000000096

Introduction: Patients with type 2 diabetes mellitus (T2DM) are commonly accepted to be predisposed to various postoperative complications. Risk assessment of these patients can rely heavily on preoperative hemoglobin A1c% (A1C), which is typically thought to represent exposure to hyperglycemia within the prior few months. However, not only can A1C be readily confounded, but it can also be an invalid index of cumulative disease progression in patients with longstanding T2DM. Thus, we hypothesized that patients with a relatively low preoperative A1C who are undergoing plastic or reconstructive breast surgeries would be no less predisposed to postoperative complications in the setting of clinically significant features of T2DM.

Methods: We performed a propensity score-matched retrospective cohort study using the US Research Network of the TriNetX platform, a large, multi-institutional research database of real-time electronic health records. Of patients with T2DM who underwent plastic or reconstructive breast surgeries, the exposure cohort comprised patients with clinical features of significant diabetic progression, such as nail dystrophy, chronic ulcers, and neuropathy, with A1C of 7.5 or below within 30 days prior to their surgery; the control cohort comprised patients with A1C greater than 7.5. Propensity score matching (1:1) was performed for demographic variables, medications, comorbidities, procedures, and body mass index classifications. Short-term outcome measures were the rates of postoperative infections, wound dehiscence, seroma, pain, emergency department visits, and hospitalizations at postoperative days 30, 60, and 90. Long-term outcome measure was the rate of significant revisions at postoperative year 2.

Results: After propensity score matching, 359 patients remained in each cohort. At postoperative day 90, the exposure cohort was at similar risks of infections, bleeding, seroma, emergency department visits, and hospitalizations and significantly higher risks of postoperative wound dehiscence (risk ratio [RR] 2.526, P-value [P] 0.0002) and pain (RR 2.154, P 0.0158). This risk profile was relatively similar across the earlier timepoints. At postoperative year 2, there was no significant difference in the revision rate. There were no outcome measures for which the exposure cohort was at significantly lower risk at any of the measured timepoints.

Conclusion: Patients with clinical features of diabetic progression were at similar if not significantly higher risks of postoperative complications, despite lower preoperative A1C, calling into question the validity of this widely used biomarker in patient risk assessment. The results of this study may challenge the conventional emphasis on A1C, suggesting instead that thorough clinical evaluations are essential to reach accurate conclusions about patients' candidacy and optimal timing for plastic and reconstructive breast surgeries.

Background: Patient-reported outcomes (PROs) have become essential in evaluating surgical quality and patient experience in breast reconstruction. While the BREAST-Q has been validated and widely implemented, its real-time clinical utility has been limited. The BREAST-Q Real-time Engagement and Communication Tool (REACT) was developed to integrate PRO scores with normative reference values, providing actionable feedback to patients and providers. This study aimed to evaluate the feasibility of an RCT investigating the implementation of BREAST-Q REACT in the perioperative setting, focusing on recruitment, protocol delivery, and preliminary clinical outcomes.

Methods: We conducted a randomized controlled feasibility trial at a single cancer center between November 2024 and February 2025. Eligible women undergoing breast-conserving surgery or mastectomy with immediate or delayed reconstruction were randomized 1:1 to standard feedback (control) or standard feedback plus REACT (intervention). Surveys included the BREAST-Q Physical Well-being of the Chest and QuickDASH at baseline, 2 weeks, 6 weeks, and 3 months postoperatively. The primary feasibility endpoints were: (1) recruitment (≥80% screened patients enrolled), (2) protocol delivery (≥75% survey completion at all time points), and (3) clinical actionability (≥50% of patients with critical scores receiving referral). Secondary outcomes compared PRO trajectories and physical therapy referrals between arms.

Results: Of 82 patients screened, 69 enrolled (84.1%, 95% CI 74.0–91.0), meeting the recruitment feasibility criterion. Among patients with critical BREAST-Q scores, 52% received timely referral (95% CI 31.8–71.7), meeting feasibility. At 6 weeks postoperatively, BREAST-Q scores were significantly higher in the REACT group compared with controls (median 76.0 vs 60.0, p <0.05). QuickDASH scores showed no significant between-group differences across time points. Physical therapy referrals occurred more often in the REACT arm (33.3% vs 23.5%), and referral time was shorter (median 1.7 vs 3.2 months), though these differences were not statistically significant. A major operational challenge was survey administration following the institutional transition to a new electronic medical record (EMR) system, which contributed to lower completion rates.

Conclusion: This feasibility study demonstrates that BREAST-Q REACT can be successfully implemented in perioperative breast reconstruction, with high recruitment, actionable PRO-guided referrals, and signals of improved early outcomes. These findings support conducting a larger randomized controlled trial to further evaluate its impact. While survey delivery was challenged by an institutional EMR transition, the overall results highlight the promise of REACT as a practical and adaptable tool for integrating patient-reported outcomes into surgical care. Broader adoption of such approaches has the potential to enhance patient engagement and improve quality of life in breast cancer patients.

Purpose Inflammatory breast cancer (IBC) is a rare, aggressive subtype with poor survival and high locoregional and systemic recurrence (1). Immediate breast reconstruction (IBR) was historically discouraged due to oncologic safety concerns (2). With recent improvements in oncologic outcomes through multimodal therapy, IBR warrants reconsideration (3). This study aims to evaluate the oncologic and surgical safety of IBR in patients with IBC.

Methods A systematic review was conducted per PRISMA guidelines. MEDLINE, EMBASE, and Cochrane databases were searched. All studies evaluating IBR among patients with IBC were included. Studies were excluded if the main reconstructive procedure was unrelated to IBC, if the reconstructive timing was delayed or if outcome data was unavailable. Study characteristics, patient demographics, clinicopathologic features, treatment details, and surgical techniques were collected. Assessed outcomes comprised survival, recurrence, surgical complications, adjuvant therapy timing, and patient-reported outcomes. Risk of bias was evaluated using the JBI Critical Appraisal Tools. Descriptive statistics were conducted.

Results Eleven retrospective studies involving 1,192 patients were included. Most patients presented with locally advanced breast cancer (stage IIIB), poor differentiation (55.4-57.5%), and axillary nodal involvement (46.1-91.6%). Hormone receptors were positive in 22.5–52.3%, HER2 in 23–38%, and triple-negative disease accounted for 14.4%. Trimodal therapy with neoadjuvant chemotherapy (91.1%), mastectomy with immediate reconstruction (100%), and adjuvant radiotherapy (91.4%) was the predominant therapeutic approach. Modified radical mastectomy was performed in 64.0%. IBR included autologous reconstruction (29.7%), implant-based reconstruction (16.0%), combined techniques (5.4%), and unspecified approaches (48.9%).

The mean length of follow-up was 53.8 months. Overall and breast cancer–specific survival was similar between IBR patients and those without reconstruction. By the last follow-up, 61.9% of patients were alive, while 38.1% had died. Locoregional recurrence occurred in 8 patients (7.1%), whereas distant metastases occurred in 19 patients (44.2%), mostly within the first postoperative year. Low rates of surgical complications were observed, including autologous tissue loss (2.1%), partial flap necrosis (4.9%), infection (6.9%), implant-related complications (7.0%), and tissue expander removal (12.5%). 26 patients required revision surgery, most commonly for elective aesthetic optimization (50%), followed by expander-to-permanent- implant exchange (27%), and surgical complications (23%). IBR did not delay adjuvant therapy, with radiotherapy initiated within 49–52 days. Patient-reported outcomes demonstrated high satisfaction and improved quality-of-life among all patients.

Conclusions In carefully selected patients with IBC, IBR can be safely integrated into multimodal therapy, offering improvements in quality-of-life without compromising oncologic outcomes. Our findings favor individualized decision-making rather than universal avoidance of IBR in patients with IBC.

References (1) Hance KW, Anderson WF, Devesa SS, Young HA, Levine PH. Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute. J Natl Cancer Inst. 2005;97(13):966-75. (2) Karadsheh MJ, Katsnelson JY, Ruth KJ, et al. Breast Reconstruction in Inflammatory Breast Cancer: An Analysis of Predictors, Trends, and Survival from the National Cancer Database. Plast Reconstr Surg Glob Open. 2021;9(4):e3528. (3) Dawood S, Merajver SD, Viens P, et al. International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol. 2011;22(3):515-23.

Background Selective Serotonin Reuptake Inhibitors (SSRIs) are widely prescribed for various psychiatric conditions and have been shown to have antiplatelet effects and modulate inflammation. However, there is limited data and conflicting evidence on wound healing and bleeding postoperatively, particularly in autologous breast reconstruction. This study investigates the relationship between SSRI use and complications in patients undergoing autologous breast reconstruction. Methods The TriNetX National Health Research Network was queried to identify patients undergoing autologous breast reconstruction with DIEP, TRAM, SIEA, and GAP flaps. Cohorts were created based on SSRI usage and matched 1:1 using propensity scoring for comorbidities including diabetes, cardiovascular disease, peripheral vascular disease, metabolic disorders, BMI, and smoking status. As a result, there were 7,346 patients with 3,673 in the SSRI cohort and 3,673 in the non-SSRI cohort. Key postoperative outcomes within 90 days of the index surgery included flap thrombosis, return to the operating room (OR), surgical site infection, wound dehiscence, hematoma, seroma, fat necrosis, need for blood transfusion, and other postoperative complications requiring inpatient management. Results After matching, the average age was 51 years old in both SSRI and non-SSRI cohorts with an average BMI of 30.1 and 30.3 kg/m2 respectively. Among SSRI users, the return to OR rates were significantly lower (6.02%) compared to non-SSRI patients (7.65%, p=0.0055). Wound dehiscence was also reduced in the SSRI group (7.30% vs. 9.37%, p=0.0013). Flap thrombosis was more common in non-SSRI patients (1.99% vs. 1.36%, p=0.0365), as were other complications requiring inpatient observation (5.94% vs. 4.47%, p=0.0045). However, there were no statistically significant differences between cohorts in rates of infection, hematomas, fat necrosis, or postoperative transfusion needs. Notably, hematomas and flaps requiring wound debridement were lower in SSRI users, although not statistically significant. Conclusion In this study, SSRI use was correlated with lower rates of flap thrombosis, return to the OR and wound healing complications with no increased complications related to bleeding. These findings suggest that continuing SSRI therapy through autologous breast reconstruction does not compromise favorable outcomes.

Background: Immediate lymphatic reconstruction (ILR) following axillary lymph node dissection (ALND) has emerged as a potential strategy to mitigate breast cancer-related lymphedema (BCRL). This present study aims to evaluate the impact of ILR on lymphedema incidence in breast cancer patients undergoing ALND and identify potential risk factors for lymphedema despite ILR. Methods: A comprehensive search was performed using PubMed, Embase, Scopus, Ovid and Google Scholar databases. Thirty studies met inclusion criteria for the meta-analysis, comprised of two randomized control trials, eight prospective observational, and 13 retrospective observational studies. The primary outcome was the incidence of lymphedema. Results: Overall, there was a 63% reduction in lymphedema risk with ILR. Among 1030 patients who underwent ILR, 14.5% developed lymphedema, compared to 25% of the 1260 patients in the control group. When pooling all ILR patients (including non comparative studies) across studies (n = 2080), 11.5% developed lymphedema. While BMI and the number of lymph nodes removed showed trends toward increased lymphedema risk in the ILR group, neither reached statistical significance (p > 0.05). There was significant variability among studies in terms of follow-up, post-operative management, and metrics for determining lymphedema. Notably, studies with longer follow-up reported higher lymphedema rates. Conclusion: ILR significantly reduces BCRL risk following ALND. Despite the heterogeneity in the existing body of literature, the meta-analysis demonstrates a consensus in the benefit of ILR for patients undergoing treatment for breast cancer.

Purpose: Direct-to-implant (DTI) is a single-stage, implant-based breast reconstruction technique after total mastectomy that avoids expansion and a planned second operation. Recent literature suggests DTI can be performed safely in elderly patients, but most work has focused on outcomes rather than resource utilization (1). As value-based surgical payment models gain traction, defining for the first time whether DTI can deliver comparable safety with lower resource utilization is increasingly relevant. This study aimed to compare hospital costs, resource utilization, and postoperative outcomes between single-stage DTI and two-stage tissue expander (TE) reconstruction in patients aged ≥65 years.

Methods: A retrospective review was conducted of patients ≥65 years of age who underwent implant-based reconstruction from 2009-2022 at a single academic center, with ≥1 year follow-up. Patients were matched 1:2 (DTI:TE) using Mahalanobis distance on age, smoking, BMI, radiation history, chemotherapy, diabetes and hypertension. Balance was assessed using standardized mean differences (SMD <.15). Total cost was defined as the sum of hospital costs from index operation through one year after the final planned reconstructive stage, estimated by applying unit costs for planned operative time (DTI: single operation; TE: expander placement and implant exchange), acellular dermal matrices, implants, inpatient length of stay (LOS), postoperative ED visits, readmissions, and reoperations. Primary outcomes were total costs and costs attributable to complications; secondary outcomes captured seroma, hematoma, fat necrosis, infection, dehiscence, capsular contracture, and explant. Analysis of unadjusted groups used t-tests and Fisher's exact tests. Analysis of the matched groups used cluster-robust gamma regression with log link and logistic regression, adjusting for implant plane, laterality, and residual imbalance (p<0.05).

Results: After matching and excluding two miscoded TE cases, 88 patients ≥65 remained (30 DTI, 58 TE). Comorbidities were balanced. DTI was more often unilateral (86.7% vs 60.3%; p=0.011), while implant planes did not differ (p=0.440).

On unadjusted analysis, patients in the DTI group had lower total costs ($12,379±$5,749 vs $16,653±$6,859; p=0.003) and operative time (200.90±99.45 vs 352.87±114.64 minutes; p<0.001), with no difference in LOS (p=0.100). Costs attributable to complications and OR time attributable to complications were lower among patients in the DTI group ($1,179±$2,793 vs $3,478±$7,089; p=0.033; and 12.24±34.55 vs 39.90±79.17 minutes; p=0.030).

In adjusted models, DTI remained associated with 15% lower total costs (aRR 0.85, 95% CI 0.73–0.99; p=0.035) driven by 36% shorter total OR time (aRR 0.64, 95% CI 0.51–0.80; p<0.001), without differences in LOS or costs attributable to complications. Odds of any complication did not differ between groups (aOR 0.39, 95% CI 0.08–1.50; p=0.178).

Conclusion: In women aged ≥65, DTI reconstruction was associated with significantly lower total costs and shorter operative time compared with TE reconstruction, without higher odds of complication or costs attributable to complications. These findings support the consideration of DTI as a safe, lower-resource option for select older patients seeking immediate reconstruction after total mastectomy.

References: 1. Maisel Lotan A, Teldan Y, Toledano R, et al. Direct-to-implant Prepectoral Breast Reconstruction in Women Older Than 65 Years: Analysis of Safety and Patient-reported Outcome. Plast Reconstr Surg Glob Open. 2025;13(3):e6647. doi:10.1097/GOX.0000000000006647

Background: In 2019, the FDA recalled Allergan BIOCELL textured breast implants for their association with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This decision was followed by a significant amount of patient and media attention regarding the safety of breast implants (1). Whether the recall selectively increased reporting of the malignancy or instead triggered a broader attention to implant-related complications remains poorly characterized (2). We investigated whether the recall decision influenced adverse reporting patterns FDA's Manufacturer and User Facility Device Experience (MAUDE) public database with the hypothesis that the recall would be associated with an increase in all breast implant reports driven by non-malignant complications, rather than a true increase in reported BIA-ALCL events. Methods: 119,942 breast implant device reports and 118,508 matched adverse event narrative (2010-2024) were analyzed. Natural language processing (NLP) classified narratives into BIA-ALCL, rupture, capsular contracture, prophylactic removal, and litigation-related reports. Non-recalled manufacturers such as Mentor and Sientra serve as natural controls for extracting recall-specific effects from media-driven reporting behavior. Manufacturer-stratified Interrupted Time Series (ITS) using Poisson regression with robust standard errors compared Allergan versus Mentor and Sientra (3). Monthly-resolution ITS with Newey-West standard errors. Sensitivity analyses including COVID-era exclusion, alternative intervention points, litigation adjustment. Holm-Bonferroni correction controlled for multiple comparisons across seven event types. Results: Following the recall, reports surged across all manufacturers: Allergan (Incidence Rate Ratio (IRR) 126.2, p < .001), Mentor (IRR 239.7, p < .001), and Sientra (IRR 193.5, p < .001). The Allergan-Mentor (IRR 0.26, p = 0.078) and Allergan-Sientra (IRR 0.29, p = 0.186) interactions were not significant. Monthly ITS demonstrated an immediate post-recall jump of 1,016 additional reports per month (p < .001). The surge was driven by non-malignant complications: capsular contracture (IRR 172.8), and rupture (IRR 63.6), all p <.001 after Holm-Bonferroni correction. BIA-ALCL reports increased in absolute number (IRR 21.9), declined proportionally from 1.6% to 0.7% of total reports. Prophylactic removal showed a uniquely accelerating trend over time (p < .001). Results were robust across sensitivity analyses excluding COVID years, adjusting for litigation, and testing alternative time points. Conclusions: The 2019 recall triggered a reporting surge across manufacturers and complication types, not limited to BIA-ALCLs, suggesting a heightened awareness or attention to reporting breast implant related complications following the 2019 recall. This infers a media-driven reporting inflation rather than a true increase in adverse events that should guide providers in counseling patients.

References 1. Dayani F, Tijerina JD, Morrison SD, Nazerali RS. Public Interest in Textured Breast Implants Recall: A Google Trends Analysis. Aesthetic Plast Surg. 2020;44(5):1489-1497. doi:10.1007/s00266-020-01724-z 2. Coroneos CJ, Selber JC, Offodile AC 2nd, Butler CE, Clemens MW. US FDA Breast Implant Postapproval Studies: Long-term Outcomes in 99,993 Patients. Ann Surg. 2019;269(1):30-36. doi:10.1097/SLA.0000000000002990 3. Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348-355. doi:10.1093/ije/dyw098

Purpose: We observed a pattern of private well water use among readmissions for infectious complications after prosthetic breast reconstruction. Given the lack of federal regulation of well water, we sought to formally evaluate household water source as a potential environmental risk factor for infection following breast reconstruction.

Methods: A retrospective analysis of patients undergoing prosthetic breast reconstruction (tissue expander or direct-to-implant) from July 2017 to October 2023 at a single academic institution was performed. Household water source was determined using publicly available real estate websites. Baseline characteristics were collected. The primary outcome was postoperative infection within 1 year, stratified as 30-day, 31–90 day, and delayed (>90 day). Secondary outcomes included other postoperative complications. Multivariable logistic regression evaluated independent associations.

Results: Among 606 patients (209 well water; 397 public water), infection occurred in 7.9%. Infection was higher in the well water group (14.4% vs. 4.5%, p<0.001), driven by increased 30-day and 31–90-day infections. Upon microbiome analysis of culture-positive patients, well water patients demonstrated greater microbial diversity than public water patients (Shannon index 2.20 vs. 1.70; 10 vs. 6 unique species). Gram-negative rods were present in both cohorts, including environmental organisms such as Serratia marcescens and Escherichia coli isolated exclusively in well water patients and Enterobacter cloacae exclusively in public water patients, while Pseudomonas aeruginosa was identified in both groups. On multivariable analysis, well water remained independently associated with infection (adjusted OR 3.42, p<0.001). Explant/TE removal rates were higher among well water patients (p=0.020) and remained independently associated with well water exposure (adjusted OR 2.08, p=0.049). Those with well water were less likely to come to the ED (p=0.016) but re-admitted twice as often (p=0.02).

Conclusion: This is the first investigation of household water source in prosthetic breast reconstruction. Well water represents a novel risk factor for infection and explant/TE removal. Perioperative risk assessment for breast reconstruction warrants inclusion of environmental exposure such as household water source, extending beyond traditional patient and operative factors.