Use Of Preoperative MRI Research Articles

Effects of preoperative breast MRI on surgical management in women aged 40 years and younger with breast cancer.

e13656 Background: Evaluating the use of preoperative breast MRI on the management of breast cancer can help guide surgical decision making for young female patients newly diagnosed with breast cancer. Methods: A retrospective chart review of the George Washington University database between January 2015 and December 2020 identified 125 women age 40 or younger diagnosed with breast cancer. Of the 125 women, 23 were excluded from the study as they were lost to follow up due to care transfers. The management impact of pre-operative MRI was examined and variables collected include age, race, family history, genetic predisposition, breast density, method of detection, initial imaging findings, initial biopsy results, preoperative MRI findings, additional biopsies, additional biopsy results, and surgery type. Results: Patient ages ranged from 22 to 40 (mean 34.5), 69 (67.6%) had a family history of breast cancer, 81 (79.4%) had dense breasts (30 extremely dense and 51 heterogeneously dense), and 82 (80.4%) had the cancer detected due to clinical symptoms with the remaining during surveillance due to high risk. Of all women included, 55 (53.9%) had additional findings on MRI warranting biopsy of which 25 (45.5%) were biopsy proven cancer. 39 (39.4%) patients had lumpectomy and 59 (59.6%) had mastectomy. 1 (0.01%) patient did not undergo surgery due to widespread metastasis. The use of preoperative MRI identified additional carcinoma in 25 (24.5%) out of 102 patients. 24 (96%) in the ipsilateral breast, and 1 (4%) in the contralateral breast. Conclusions: Overall, this data indicates that the use of preoperative MRI for the treatment of breast cancer in young patients increases the detection of occult breast cancer prior to definitive therapy in 24.5% of patients, critically important information for optimal management. We recommend that all young women with newly diagnosed breast cancer undergo pre-operative MRI to further optimize patient care.

Resection of colorectal carcinoma liver metastases: A population-based study in outcomes and factors associated with recurrent disease

ObjectiveTo assess the hepatic disease-free survival (HDFS) and overall survival (OS) of patients who underwent resection of colorectal cancer liver metastases (CRCLM) in our population, and evaluate what factors are associated with these outcomes. MethodsPatients with resected non-mucinous CRCLM between January 2013-February 2020 were retrospectively identified. Dates of diagnosis, surgery, and, if applicable, death were recorded. HDFS and OS were calculated using a census date of 24 September 2022. Separate Cox multivariate regression analyses were performed to evaluate for association between HDFS and OS and the following factors: pre-operative imaging interval (<4 weeks vs. ≥4 weeks); pre-operative imaging modality (CT only vs. MRI+CT); extrahepatic disease at time of hepatectomy (yes vs. no); tumor burden score (TBS, where TBS2 = (largest axial dimension of CRCLM)2 + (number of CRCLM)2); pT and pN; and neoadjuvant chemotherapy. Results137 subjects (mean age, 61 ± 11 years, 86 males) were included. Associations with recurrent hepatic disease were found with chemotherapy (HR 2.11[95 % CI = 1.13–3.92]), TBS (HR 1.30[95 % CI = 1.17–1.45]), MRI+CT (HR 2.12[95 % CI = 1.29–3.48]), and extrahepatic disease at hepatectomy (HR 2.16[95 % CI = 1.08–4.35]). For mortality, associations were found with TBS (HR 1.22[95 % CI = 1.09–1.37]), pT (HR 1.45[95 % CI = 1.05–2.00]), and extrahepatic disease at hepatectomy (HR 2.10[95 % CI = 1.31–3.36]). ConclusionIn our population, non-imaging related factors TBS, neoadjuvant chemotherapy, pT and presence of extrahepatic disease at time of hepatectomy were associated with HDFS and/or OS. The preoperative imaging interval and use of preoperative MRI were not associated with improved patient outcomes.

Lymph Node Positivity: Indication for Preoperative MRI?

The purpose was to determine what factors help predict benefit from preoperative MRI. We conducted an IRB approved retrospective review of patients with breast cancer who underwent preoperative MRI (2018-2021). Patients were divided into a cohort of no new disease detected on MRI versus new disease detected. Of 420 patients with a new diagnosis of breast cancer who underwent preoperative MRI, 17% had new multicentric, multifocal, or contralateral disease detected. There was no difference between the two cohorts for age (p = 0.23), race (p = 0.45), family history (p = 0.47), breast density (p = 0.14), or hormone status (p = 0.90). In multivariate analysis, age (p = 0.61, OR 0.99), race (p = 0.58, OR 1.26), family history (p = 0.54, OR 0.82), breast density (p = 0.83, OR 0.87), grade (p = 0.87, OR 1.09), tumor size (p = 0.37, OR 0.92), and use of neoadjuvant therapy (p = 0.41, OR 0.72) were not predictive of detection of additional new disease. Presence of positive nodes on ultrasound or mammogram was associated with new or multifocal disease on MRI (p = 0.0005, OR 3.48). Pre-MRI positive nodes increased the likelihood of detection of new disease (p = 0.0002, OR 3.04). Preoperative MRI resulted in more extensive surgery than indicated for 22.2% of the no new disease detected cohort and 6.9% of the new multicentric disease cohort (p < 0.001). Patients with nodal disease detected in their evaluation are more likely to have new multifocal, multicentric, or contralateral disease detected on MRI. The use of preoperative MRI may be particularly helpful in patients with node-positive disease in identifying additional disease that would alter surgical management.

Deep motor cortex cavernoma resection supported by navigational intraoperative monitoring

Introduction: Cavernomas are benign hamartomas of cerebral and spinal vessels, accounting for less than 1% of all arteriovenous malformations. In general, surgical resection is the treatment of choice for enlarging cavernomas or those associated with medically refractory seizures. Herein, we report a case of an enlarged deep precentral gyrus cavernoma, with a discussion of the surgical approach and the impact of intra-operative neurophysiological monitoring on the preservation of motor function. Case description: A 30-year-old male was referred to our hospital due to 2-month history of focal seizures. Initial magnetic resonance imaging revealed right precentral cavernoma with minimal right parietal subarachnoid haemorrhage. Revealed the location of the cavernoma deep in the right primary motor cortex. Surgery was performed, trans-sulcal dissection was done with the aid of intraoperative ultrasonography neuro-navigation. The cortical motor map was localized by functional mapping with intra-operative neurophysiological monitoring, including somatosensory evoked potentials (SEP) and motor evoked potentials (MEP). Post-operatively, the left side weakness grade was 4/5, and the Glasgow coma scale was 15. Postoperative imaging confirmed successful resection of the cavernoma and associated hemosiderin ring with no SAH. Conclusion: The use of preoperative MRI and intraoperative ultrasonography supplemented by neurophysiological monitoring utilizing SEP, MEP, and cortical mapping is essential for the safe resection of paracentral cavernomas.

Clinical value of contralateral breast cancers detected by pre-operative MRI in patients diagnosed with DCIS: a population-based cohort study

ObjectivesFor patients with ductal carcinoma in situ (DCIS), data about the impact of breast MRI at primary diagnosis on the incidence and characteristics of contralateral breast cancers are scarce.MethodsWe selected all 8486 women diagnosed with primary DCIS in the Netherlands in 2011–2015 from the Netherlands Cancer Registry. The synchronous and metachronous detection of contralateral DCIS (cDCIS) and contralateral invasive breast cancer (cIBC) was assessed for patients who received an MRI upon diagnosis (MRI group) and for an age-matched control group without MRI.ResultsNineteen percent of patients received an MRI, of which 0.8% was diagnosed with synchronous cDCIS and 1.3% with synchronous cIBC not found by mammography. The 5-year cumulative incidence of synchronous plus metachronous cDCIS was higher for the MRI versus age-matched control group (2.0% versus 0.9%, p = 0.02) and similar for cIBC (3.5% versus 2.3%, p = 0.17). The increased incidence of cDCIS was observed in patients aged < 50 years (sHR = 4.22, 95% CI: 1.19–14.99), but not in patients aged 50–74 years (sHR = 0.89, 95% CI: 0.41–1.93).ConclusionsMRI at primary DCIS diagnosis detected additional synchronous cDCIS and cIBC, and was associated with a higher rate of metachronous cDCIS without decreasing the rate of metachronous cIBC. This finding was most evident in younger patients.Key Points• Magnetic resonance imaging at primary diagnosis of ductal carcinoma in situ detected an additional synchronous breast lesion in 2.1% of patients.• In patients aged younger than 50 years, the use of pre-operative MRI was associated with a fourfold increase in the incidence of a second contralateral DCIS without decreasing the incidence of metachronous invasive breast cancers up to 5 years after diagnosis.• In patients aged over 50 years, the use of pre-operative MRI did not result in a difference in the incidence of a second contralateral DCIS or metachronous invasive breast cancer.

ASO Author Reflections: Does Use of Preoperative MRI Reduce Reexcision Rate in Patients with TNBC? Maybe, But It Is Complicated.

ASO Author Reflections: Does Use of Preoperative MRI Reduce Reexcision Rate in Patients with TNBC? Maybe, But It Is Complicated.

Preoperative MRI to Improve Aesthetic Outcomes in Secondary Mastopexy Augmentation: A Step-by-Step Approach.

Secondary mastopexy augmentation is challenging because of compromised blood supply to the nipple areola complex (NAC). The operating surgeon often relies on clinical judgment and may perform a more conservative elevation of the NAC to minimize the risk of nipple necrosis. Despite this, the danger of necrosis persists. In our experience, MRI with contrast has enhanced preoperative planning in both cosmetic and reconstructive cases. The goals of this article are to describe our use of preoperative MRI in identifying the blood supply to the NAC, evaluating dermo glandular thickness, decreasing surgical complications, and improving outcomes in secondary mastopexy augmentation. A consecutive series of secondary mastopexy augmentation procedures performed in 2021 were reviewed. In each case, preoperative maximum intensity projection (MIP) and/or high-resolution T1-weighted contrast enhanced MRI imaging was reviewed to elucidate the blood supply to the NAC and quantify the dermo glandular thickness. The imaging was used to formulate the operative plan. Preoperative and postoperative photographs were compared. Eight cases were performed, four of which were selected to demonstrate our method using breast MRI with contrast in step-by-step approach. Patient satisfaction was high. The NAC survived in all cases. Surgeons can utilize preoperative breast MRI for strategic operative planning when performing secondary mastopexy augmentation. Visualization of the blood supply to the NAC and dermo glandular flap thickness are vitally important when performing a more aggressive lift of the breast.

Are we choosing wisely? Drivers of preoperative MRI use in breast cancer patients

IntroductionFactors contributing to the use of preoperative MRI remain poorly understood. MethodsData from a randomized controlled trial of stage 0–3 breast cancer patients undergoing breast conserving surgery between 2016 and 2018 were analyzed. ResultsOf the 396 patients in this trial, 32.6% had a preoperative MRI. Patient age, race, ethnicity, tumor histology, and use of neoadjuvant therapy were significant predictors of MRI use. On multivariate analysis, younger patients with invasive lobular tumors were more likely to have a preoperative MRI. Rates also varied significantly by individual surgeon (p < 0.001); in particular, female surgeons (39.9% vs. 24.0% for male surgeons, p = 0.001) and those in community practice (58.9% vs. 14.2% for academic, p < 0.001) were more likely to order preoperative MRI. Rates declined over the two years of the study, particularly among female surgeons. ConclusionsPreoperative MRI varies with patient age and tumor histology; however, there remains variability by individual surgeon.

Validated prediction model for positive resection margins in breast-conserving surgery based exclusively on preoperative data.

BackgroundPositive margins after breast-conserving surgery (BCS) and subsequent second surgery are associated with increased costs and patient discomfort. The aim of this study was to develop a prediction model for positive margins based on risk factors available before surgery.MethodsPatients undergoing BCS for in situ or invasive cancer between 2015 and 2016 at site A formed a development cohort; those operated during 2017 in site A and B formed two validation cohorts. MRI was not used routinely. Preoperative radiographic and tumour characteristics and method of operation were collected from patient charts. Multivariable logistic regression was used to develop a prediction model for positive margins including variables with discriminatory capacity identified in a univariable model. The discrimination and calibration of the prediction model was assessed in the validation cohorts, and a nomogram developed.ResultsThere were 432 patients in the development cohort, and 190 and 157 in site A and B validation cohorts respectively. Positive margins were identified in 77 patients (17.8 per cent) in the development cohort. A non-linear transformation of mammographic tumour size and six variables (visible on mammography, ductal carcinoma in situ, lobular invasive cancer, distance from nipple–areola complex, calcification, and type of surgery) were included in the final prediction model, which had an area under the curve of 0.80 (95 per cent c.i. 0.75 to 0.85). The discrimination and calibration of the prediction model was assessed in the validation cohorts, and a nomogram developed.ConclusionThe prediction model showed good ability to predict positive margins after BCS and might, after further validation, be used before surgery in centres without the routine use of preoperative MRI.Presented in part to the San Antonio Breast Cancer Symposium, San Antonio, Texas, USA, December 2018 and the Swedish Surgical Society Annual Meeting, Helsingborg, Sweden, August 2018.

Clinical Practice Patterns in Nonsyndromic Craniosynostosis: A Review of Continuous Certification Tracer Data From the American Board of Plastic Surgery.

Abstract Since 2003, the American Board of Plastic Surgery has collected data on 20 plastic surgery operations as part of the Maintenance of Certification process. The goal of this study was to describe national trends in craniosynostosis repair as they relate to Evidence-Based Medicine (EBM) articles published during this timeframe. Cumulative tracer data for nonsyndromic craniosynostosis were reviewed from 2006 to March 2020, and compared with EBM articles published in Plastic and Reconstructive Surgery. Topics were categorized as: As of March 2020, 940 cases of nonsyndromic craniosynostosis had been entered. The median age at the time of surgery was 8 months (range, 1–204 months). Practice patterns from 2006 through 2013 were compared with those between 2013 and 2020. The most common surgical technique from 2006 through 2013 was anterior regional cranioplasty, and from 2013 to 2020 was orbital rim advancement. Differences in practice between these time periods included an increase in patients with asymptomatic clinical presentation (27% versus 42%, P &lt; 0.001) and presentation with papilledema (1% versus 4%, P = 0.003). Use of preoperative MRI significantly increased (1% versus 6%, P &lt; 0.001). Significant changes were noted in surgical technique and methods of fixation. By examining the American Board of Plastic Surgery tracer data, the authors can describe national trends in presentation, imaging, and surgical techniques for non -syndromic craniosynostosis repair over a 14-year period.

Preoperative MRI for predicting pathological changes associated with surgical difficulty during laparoscopic cholecystectomy for acute cholecystitis.

BackgroundSevere inflammation with necrosis and fibrosis of the gallbladder in acute cholecystitis increases operative difficulty during laparoscopic cholecystectomy. This study aimed to assess the use of preoperative MRI in predicting pathological changes of the gallbladder associated with surgical difficulty.MethodsPatients who underwent both preoperative MRI and early cholecystectomy for acute cholecystitis between 2012 and 2018 were identified retrospectively. On the basis of the layered pattern of the gallbladder wall on MRI, patients were classified into three groups: high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI). The endpoint was the presence of pathological changes of the gallbladder associated with surgical difficulty, such as necrosis, abscess formation and fibrosis.ResultsOf 229 eligible patients, pathological changes associated with surgical difficulty were found in 17 (27 per cent) of 62 patients in the HSI group, 84 (85 per cent) of 99 patients in the ISI group, and 66 (97 per cent) of 68 patients in the LSI group (P < 0·001). For detecting these changes, intermediate to low signal intensity of the gallbladder wall had a sensitivity of 90 (95 per cent c.i. 84 to 94) per cent, specificity of 73 (60 to 83) per cent and accuracy of 85 (80 to 90) per cent.ConclusionPreoperative MRI predicted pathological changes associated with surgical difficulty during laparoscopic cholecystectomy for acute cholecystitis.

The Value of Patient and Tumor Factors in Predicting Preoperative Breast MRI Outcomes.

To identify patient and tumor features that predict true-positive, false-positive, and negative breast preoperative MRI outcomes. Using a breast MRI database from a large regional cancer center, the authors retrospectively identified all women with unilateral breast cancer who underwent preoperative MRI from January 2005 to February 2015. A total of 1396 women with complete data were included. Patient features (ie, age, breast density) and index tumor features (ie, type, grade, hormone receptor, human epidermal growth factor receptor type 2/neu, Ki-67) were extracted and compared with preoperative MRI outcomes (ie, true positive, false positive, negative) using univariate (ie, Fisher exact) and multivariate machine learning approaches (ie, least absolute shrinkage and selection operator, AutoPrognosis). Overall prediction performance was summarized using the area under the receiver operating characteristic curve (AUC), calculated using internal validation techniques (bootstrap and cross-validation) to account for model training. At the examination level, 181 additional cancers were identified among 1396 total preoperative MRI examinations (median patient age, 56 years; range, 25-94 years), resulting in a positive predictive value for biopsy of 43% (181 true-positive findings of 419 core-needle biopsies). In univariate analysis, no patient or tumor feature was associated with a true-positive outcome (P > .05), although greater mammographic density (P = .022) and younger age (< 50 years, P = .025) were associated with false-positive examinations. Machine learning approaches provided weak performance for predicting true-positive, false-positive, and negative examinations (AUC range, 0.50-0.57). Commonly used patient and tumor factors driving expert opinion for the use of preoperative MRI provide limited predictive value for determining preoperative MRI outcomes in women. Supplemental material is available for this article. © RSNA, 2020See also the commentary by Grimm in this issue.

P080: The impact of pre-operative breast MRI in patients undergoing therapeutic mammoplasty

Introduction: There are NICE and RCR guidelines (2016 & 2019) on the use of pre-operative MRI in planning surgery for breast cancer. However, there is no body of work considering its use in guiding advanced oncoplastic surgical techniques such as therapeutic mammoplasty.

Preoperative MRI Shoulder Findings Associated with Clinical Outcome 1 Year after Rotator Cuff Repair.

Background Investigation of the use of preoperative MRI for providing prognostic information regarding clinical outcome following rotator cuff repair has been limited. Purpose To determine whether patients with more severe rotator cuff tears of the shoulder at preoperative MRI have a greater degree of residual pain and disability after rotator cuff repair. Materials and Methods This retrospective study included a cohort of 141 patients who underwent surgical repair of a full-thickness rotator cuff tear at a single institution between April 16, 2012, and September 3, 2015. The mean patient age was 56.8 years, and there were 100 men (mean age, 56.1 years) and 41 women (mean age, 56.3 years). Patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) survey (lower score indicates less pain and disability) before and 1 year after surgery. One musculoskeletal radiologist blinded to the DASH scores measured the maximal anterior-posterior width and medial-lateral retraction of the rotator cuff tear on the preoperative MRI and assessed tendon degeneration and composite muscle atrophy and fatty infiltration using categorical grading scales (grade 0 indicates no tendon degeneration or muscle atrophy and fatty infiltration, and higher grades indicate incrementally more severe tendon degeneration or muscle atrophy and fatty infiltration). Generalized estimating equation models were used to determine the association between preoperative MRI findings and the postoperative DASH score. Results There was a significant positive association (P < .05) between the measured tear width (estimate, 2.05), measured tear retraction (estimate, 3.52), and tendon degeneration grade (estimate, 1.59) and the postoperative DASH score. There was no significant association (P = .49) between the composite muscle atrophy and fatty infiltration grade (estimate, 0.31) and the postoperative DASH score. Conclusion Patients with larger rotator cuff tears, more tendon retraction, and more severe tendon degeneration have worse clinical outcome scores 1 year after rotator cuff repair. © RSNA, 2019.

The usefulness of preoperative MRI for improving donor safety

The usefulness of preoperative MRI for improving donor safety

The Use of Breast MRI for Patients With Preoperative Breast Cancer in an Underserved Population

BackgroundUse of MRI for preoperative evaluation of newly diagnosed breast cancer has become more common, despite questionable impact on outcomes. We sought to determine how often and in what manner preoperative breast MRI changed surgical management in an underserved patient population. Materials and methodsWe examined the use of preoperative MRI at Bellevue Hospital Center (BHC), a public, tertiary hospital in lower Manhattan with a large underserved population. The BHC breast clinic database was used to identify patients who received preoperative MRI for breast cancer between January 2015 and December 2016. MRI was defined as changing surgical management in a positive manner if an MRI-detected abnormality had verification of malignancy in the final surgical specimen, confirming the MRI indication for wider excision or mastectomy, while MRI was defined to change surgical management in a negative manner if final pathology was discordant with MRI. Chi-square test was used to analyze characteristics of those who received MRI versus those who did not. ResultsA total of 208 patients underwent breast surgery at BHC, and 62 patients underwent MRI for preoperative planning purposes. There were significant differences between the MRI and no MRI group in terms of ethnicity (P = 0.05), age (P < 0.01), and type of surgery (P = 0.03). 50% of the biopsies performed as a result of MRI were benign. MRI changed surgical management in 35 % of patients, most commonly by converting lumpectomy to mastectomy. Of cases in which MRI changed surgical management, most were positive changes. However, 4 patients underwent surgery and 11 patients underwent biopsy for benign pathology as a result of MRI findings. ConclusionsMRI requires significant hospital and patient resource utilization. Especially in an underserved population, decision for MRI must be individualized, taking into account the risks and benefits of ordering this test.

The usefulness of preoperative MRI in synchronous bilateral breast cancer

The usefulness of preoperative MRI in synchronous bilateral breast cancer

Relationship between preoperative breast MRI and surgical treatment of non-metastatic breast cancer.

More extensive surgical treatments for early stage breast cancer are increasing. The patterns of preoperative MRI overall and by stage for this trend has not been well established. Using Breast Cancer Surveillance Consortium registry data from 2010 through 2014, we identified women with an incident non-metastatic breast cancer and determined use of preoperative MRI and initial surgical treatment (mastectomy, with or without contralateral prophylactic mastectomy (CPM), reconstruction, and breast conserving surgery ± radiation). Clinical and sociodemographic covariates were included in multivariable logistic regression models to estimate adjusted odds ratios and 95% confidence intervals. Of the 13 097 women, 2217 (16.9%) had a preoperative MRI. Among the women with MRI, results indicated 32% higher odds of unilateral mastectomy compared to breast conserving surgery and of mastectomy with CPM compared to unilateral mastectomy. Women with preoperative MRI also had 56% higher odds of reconstruction. Preoperative MRI in women with DCIS and early stage invasive breast cancer is associated with more frequent mastectomy, CPM, and reconstruction surgical treatment. Use of more extensive surgical treatment and reconstruction among women with DCIS and early stage invasive cancer whom undergo MRI warrants further investigation.

Factors Affecting Choice of Treatment for Early-Stage Breast Cancer in West Virginia: A 10-Year Experience from a Rural Tertiary Care Center

Recent literature shows changing trends in use of breast conservation surgery (BCS), mastectomy, and contralateral prophylactic mastectomy (CPM) in women with early-stage breast cancer (ESBC). We analyzed factors associated with selection of these treatment modalities in a rural West Virginia tertiary care hospital. We conducted a 10-year analysis of women treated for ESBC at our institution from the institutional cancer registry. Variables were compared between patients choosing BCS versus mastectomy. In women who chose mastectomy, predictors for choice of CPM were also examined. Variables with P < 0.05 on univariate analysis were entered into a multivariate logistic regression model to define independent predictors of treatment choice. The mastectomy rate increased from 18.0 per cent in 2006 to 40.2 per cent in 2013. On multivariate analysis, insurance status (P < 0.001), comorbidities (P = 0.001), and surgeon graduation after 1987-a surrogate for surgeon age-(P = 0.010) predicted receipt of mastectomy. Of those receiving mastectomy, 106 (25.1%) elected CPM. CPM rates increased from 8.0 per cent in 2006 to 45.0 per cent in 2013. Younger age at diagnosis (P < 0.001) and use of preoperative MRI (P = 0.012) independently predicted use of CPM versus unilateral mastectomy. Rates of mastectomy and CPM in ESBC have increased in West Virginia over time. Independent predictors of selecting mastectomy over BCS included insurance status, surgeon age, and associated comorbidities. Younger patients and patients receiving preoperative MRI were more likely to choose CPM. Awareness of these factors will aid in counseling women with ESBC and allow clinicians to address potential biases or disparities that may affect treatment choices. Further prospective study of these findings is warranted.

Abstract P3-14-02: Post mastectomy breast reconstruction in elderly women: Complications and the impact of individual surgeons

Abstract Purpose/Objective In the United States over 40% of incident breast cancer diagnoses are in women over 65 years of age. Effective breast cancer treatments allow elderly patients to live long, healthy lives; questions regarding long-term quality of life are increasingly important. In women over 65, post-mastectomy breast reconstruction (PMBR) is uncommon with reported rates of 6-30%. The goal of this study is to report complication rates in elderly PMBR patients and to evaluate the impact of individual surgeons on PMBR in elderly patients. Material/methods We identified 19,417 Medicare beneficiaries diagnosed with localized breast cancer between 2005 and 2011 who underwent mastectomy. Medicare claims were used to identify PMBR, post-operative complications after PMBR (within 30 days of surgery), and long-term complications related to reconstruction (within three years following surgery). Mastectomy surgeon was identified from Medicare claims with surgeon characteristics identified through linkage to the American Medical Association (AMA) Masterfile. Multi-level, multivariable logistic models clustered by surgeon and geographic area were used to determine the impact of surgeons on the likelihood of reconstruction. The intraclass correlation coefficient (ICC) and median odds ratio (MOR) were used to describe the relative impact of the individual surgeon. The ICC estimates the proportion of variability explained by the surgeon on PMBR rates. The MOR quantifies the likelihood of a patient having a different PMBR outcome if the patient were to change surgeons (or geographic area); it is directly comparable to odds ratios. Odds ratios (OR) were used to describe the impact of fixed demographic and clinical covariates. Results Among the entire cohort, 1,234 (6.4%) patients underwent PMBR. The post-operative complication rate was 8.4% and the long-term complication rate was 19.9%. Eighteen percent of the variability in PMBR use was attributed to the individual surgeon (ICC 0.181). The MOR for surgeon was found to be 1.85 (95% CI [1.70,1.99]), indicating that a patient had an 85% chance of having a different outcome (receiving or not receiving PMBR) if the patient saw a different mastectomy surgeon. The MOR for geographic area indicated that a patient had a 32% chance of having a different outcome if the patient saw a surgeon in a different geographic area (1.32, 95% CI [1.17, 1.47]). Patients who were Asian, single, older, of lower socioeconomic status, and underwent radiation therapy were less likely to undergo PMBR. Patients who had pre-operative MRI or received chemotherapy were more likely to undergo PMBR. Patients who were treated by female surgeons or plastic surgeons were significantly more likely to undergo PMBR. Overall, the individual surgeon was the most predictive of PMBR, except for the use of pre-operative MRI and mastectomy surgeon's specialty being plastic surgery. Conclusion A small minority of older women undergo PMBR despite having low post-operative and long-term complication rates. The individual surgeon and geographic area significantly influences whether older breast cancer patients will undergo PMBR. Future research should focus on surgeon characteristics that may influence a patient's decision to undergo PMBR. Citation Format: Schoenbrunner AR, Fero KE, Boero IJ, Matsuno R, Kronstadt N, Lance S, Reid C, Wallace AM, Gosman AA, Murphy JD. Post mastectomy breast reconstruction in elderly women: Complications and the impact of individual surgeons [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-02.