PC43. Satisfaction with Breasts among Patients Undergoing Abdominal Free Flap Breast Reconstruction: Identification of Factors in 919 Patients

Abstract

PURPOSE: Previous studies suggest that patients who choose autologous breast reconstruction have significantly higher satisfaction with their breasts than those with implant-based reconstruction. Of all donor sites, abdominal-based reconstruction has become the gold standard. This study aimed to present factors associated with Satisfaction with Breasts among patients who underwent abdominal free flap breast reconstruction. METHODS: We performed a retrospective analysis of women with abdominal-based breast reconstruction between 2010 and 2021. Patients who completed the BREAST-Q Satisfaction with Breasts module and underwent either transverse rectus abdominis myocutaneous (TRAM), deep inferior epigastric artery perforator (DIEP), or superficial inferior epigastric artery (SIEA) were included. RESULTS: Overall, 919 women who underwent abdominal-based breast reconstruction completed the BREAST-Q at 1-year follow-up. The median score improved from 46 (interquartile range, 33 to 58) preoperatively to 64.0 (53 to 78) at 1-year postoperatively. Factors significantly associated with decreased postoperative Satisfaction with Breasts score included lower preoperative scores (beta=0.12, p=0.012), Black (beta=-4.7, p=0.031) or Other ethnicity (beta=-13, p<0.001, versus White), and history of psychiatric (beta=-5.4, p<0.001) and cardiovascular disease (beta=-4.0, p=0.010). Patients who had radiation reported significantly decreased score compared to those who did not (beta=-6.5, p<0.05). Variables including BMI, timing of reconstruction (immediate versus delayed), laterality, and complications were not associated with the 1-year postoperative score. CONCLUSION: Factors that influence long-term Satisfaction with Breasts following autologous breast reconstruction include lower preoperative score, Black or Other race, a history of psychiatric or cardiovascular disorders, and radiation. Understanding these factors is imperative in managing expectations and preoperative counseling.