The significance of timing in breast reconstruction after mastectomy: An ACS-NSQIP analysis

Safety of Combined Versus Isolated Cosmetic Breast Surgery and Abdominoplasty: Insights from a Multi-institutional Database

INTRODUCTION

Abdominoplasty and breast surgery are popular cosmetic procedures, often performed as stand-alone or combined procedures. However, the safety of combining these surgeries remains poorly understood.

METHODS

We analyzed data from the ACS-NSQIP database spanning 2008-2021, focusing on patients who underwent isolated cosmetic breast surgery, isolated cosmetic abdominoplasty, or the combination of both. We evaluated four primary outcomes: general complications (reoperation, readmission, mortality), surgical complications, medical complications, and overall complications (general + surgical + medical). Further analysis considered the specific type of cosmetic breast surgery.

RESULTS

A total of 7865 female patients were identified, of whom 20.5% underwent isolated abdominoplasty, 65.3% cosmetic breast surgery, and 14.2% combined abdominoplasty with concurrent cosmetic breast surgery. Combined surgery was associated with a significantly higher risk of reoperations (OR 2.07; p = 0.04) compared to abdominoplasty alone. However, there was no significant difference in overall complications (OR 1.17; p = 0.40), surgical complications (OR 0.72; p = 0.26), or medical complications (OR 0.97; p = 0.91) between these two groups. Comparing combined to isolated cosmetic breast surgery, there was a higher risk of overall complications (OR 1.70; p = 0.04) and medical complications (OR 5.30; p < 0.0001) but no significant difference in general complications (OR 1.40; p = 0.33) or surgical complications (OR 0.85; p = 0.73).

CONCLUSION

Combining breast surgery with abdominoplasty increases the risk of reoperations but does not elevate the risk of surgical or medical complications. However, patients seeking combined surgeries are more likely to experience adverse events than those seeking isolated cosmetic breast surgery.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Unveiling Inequities: Racial Disparities in Risk-Reducing Mastectomy for Breast Cancer Prevention

BACKGROUND

Risk-reducing mastectomy (RRM) significantly lowers breast cancer risk as a preventive surgery. While racial disparities in breast cancer treatment are well-documented, research on racial differences in the utilization and outcomes of RRM is limited.

METHODS

We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program (2008-2022) to identify women who underwent RRM. Patient demographics, comorbidities, surgical characteristics, and 30-day postoperative outcomes were compared between White and racial minority patients, including Black/African American women.

RESULTS

Among 1,285 patients, 88% (n = 1,126) self-identified as White and 12.4% (n = 159) as racial minorities, including 5.8% (n = 74) Black. Minority patients were younger than White patients (50.7±11.4 years vs. 52.6±12.6 years; P = .66). Black patients had a significantly higher mean BMI than White patients (33.6±8.4 kg/m² vs. 30.6±8.0 kg/m²; P = .03), and higher prevalence of obesity (65%, n = 48 vs. 47%, n = 524; P = .03) and hypertension (51%, n = 38 vs. 30%, n = 342; P = .007). Racial minority patients were more likely to undergo outpatient surgery (81%, n = 129 vs. 57%, n = 645; P < .001) and had shorter hospital stays than White patients (0.8±1.3 days vs. 1±2 days; P = .001). Black patients experienced higher rates of superficial incisional infections (9.5%, n = 7 vs. 2.9%, n = 33; P = .18) and overall complications (18%, n = 13 vs. 10%, n = 113; P = .48) CONCLUSION: This multi-institutional study reveals racial disparities in RRM, with minority patients significantly more likely to present with comorbidities and experience higher complication rates. These findings underscore the need for targeted strategies to ensure equitable access to RRM and improve outcomes for minority patients, advancing health equity in breast cancer prevention.

One-Year Quality of Life Outcomes of Delayed Unilateral Autologous Breast Reconstruction and Associated Patient Factors

Introduction

As breast cancer survival rates improve, the long-term quality of life (QoL) has become increasingly important. With a significant number of patients still undergoing mastectomy and experiencing its well-known negative impacts on QoL, breast reconstruction aims to mitigate this by restoring body integrity. This study aimed to evaluate the changes in QoL and satisfaction in patients after breast reconstruction and influence of various patient-related factors.

Methods

Patients who underwent delayed unilateral deep inferior epigastric perforator (DIEP) breast reconstruction at a single institution between January 2016 and April 2019 were surveyed. QoL was assessed using the BREAST-Q questionnaire preoperatively and one year postoperatively. Scores were compared between the time points, and regression analysis was conducted to identify the influence of age, body mass index, economic status, education level, and relationship status on QoL.

Results

Among the 93 patients, 55 completed the preoperative and one-year postoperative BREAST-Q questionnaires (response rate: 59%). Postoperative QoL scores significantly increased for the domains "satisfaction with breasts," physical well-being chest," "sexual well-being," and "psychosocial well-being" (p<0.001). The scores for the domain "physical well-being abdomen" remained unchanged one year postoperatively. Higher education correlated with greater satisfaction with the breasts. Lack of an intimate partnership was identified as a significant negative factor for poorer psychosocial well-being.

Conclusions

Delayed unilateral DIEP breast reconstruction significantly enhances QoL and breast satisfaction one year postoperatively without causing long-term physical discomfort at the donor site. Education level and relationship status significantly affect the postoperative outcomes. Tailored preoperative counseling and psychosocial support are essential to maximize patient satisfaction and well-being following reconstruction.

The Impact of Body Mass Index on Breast Reduction Outcomes: A Multi-Institutional Data Analysis of 45,000 Cases over 15 Years

BACKGROUND

The caseload of breast reduction is on the rise. Despite this popularity, the association between body mass index (BMI) and postoperative outcomes remains unclear. We hypothesize that BMI is a significant determinant of postoperative morbidity after breast reduction and leverage a multi-institutional database to investigate this correlation.

METHODS

We queried the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) (2008-2022) to identify female adult patients who underwent breast reduction. We categorized all patients into six BMI subgroups, and compared their outcomes (i.e., 30-day surgical and medical complications, reoperation, readmission, and mortality) via multivariate logistic regression analyses.

RESULTS

45,373 patients (mean age: 40 ± 14 years; mean BMI: 31 ± 6.1 kg/m2) were identified, of whom 0.1% (n = 61) were underweight, 12% (n = 5635) healthy weight, 34% (n = 15,346) overweight, 30% (n = 13,795) had obesity I, 15% (n = 6843) obesity II, and 8.1% (n = 3693) obesity III. Overall, 2881 (6.4%) patients experienced complications, with 1936 (4.3%) cases of surgical complications and 317 (0.7%) cases of medical complications. The risk for complications increased stepwise above the healthy BMI range. Compared to women with healthy weight, patients with obesity I, II, and III had a significantly higher risk of any complication (OR 1.5, p < 0.001; OR 1.87, p < 0.001; and OR 2.6, p < 0.001, respectively), medical complications (OR 2.4, p = 0.005; OR 2.99, p = 0.001; and OR 5.2, p < 0.001, respectively), and surgical complications (OR 2.2, p < 0.001; OR 2.81, p < 0.001; and OR 4.2, p < 0.001, respectively). Overweight patients were also at higher risk for any complication (OR 1.2, p = 0.09), medical complications (OR 2.1, p = 0.02), and surgical complications (OR 1.4, p = 0.004). The odds for reoperation did not increase with higher BMI classes.

CONCLUSION

Our multi-institutional data analysis revealed a significant correlation between elevated BMI and the occurrence of both surgical and medical complications after breast reduction surgery. The postoperative risk increased progressively with BMI above the healthy range. These findings are essential for informing preoperative counseling, refining risk assessment, and developing tailored protocols.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

The Use of Acellular Dermal Matrix May Not Increase 30-Day Complications in Direct-to-Implant Breast Reconstruction: A Multi-institutional Analysis of 10,177 Cases

BACKGROUND

Direct-to-implant (DTI) breast reconstruction offers immediate aesthetic and psychological benefits, but the role of acellular dermal matrix (ADM) remains debated. Using a multi-institutional database, this study evaluates and compares outcomes between ADM-assisted and non-ADM DTI procedures.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2022 was queried to identify female patients who underwent DTI breast reconstruction for oncological purposes. Patients were divided into 2 groups: DTI breast reconstruction with ADM and without. Thirty-day postoperative complications were compared using multivariate analysis and propensity score matching.

RESULTS

Among 10,177 patients, 45% (n = 4605) underwent ADM-assisted DTI, while 55% (n = 5572) had non-ADM DTI. While both groups showed comparable mean ages (ADM: 52 ± 12 years vs non-ADM: 51 ± 11 years; P = 0.190), ADM patients were significantly less likely to present with comorbidities such as obesity (ADM: 21.5% vs non-ADM: 26%; P < 0.001), hypertension (20.5% vs 2.6%; P = 0.01), diabetes (4.8% vs 5.1%; P = 0.002), and smoking history (6.4% vs 10.1%; P < 0.001). Still, surgical complication rates were comparable (ADM: 4.7%, non-ADM: 5.5%; P = 0.08), including superficial infections (2.0% vs 2.4%; P = 0.19), deep infections (0.6% vs 0.9%; P = 0.17), wound dehiscence (0.8% vs 1.0%; P = 0.24), and bleeding (0.6% vs 0.7%; P = 0.54). Medical complications were generally rare and also showed no significant differences (ADM: 1.4%, non-ADM: 1.7%; P = 0.27). Confounder-adjusted multivariable analysis and propensity score matching confirmed no increased risk of surgical (odds ratio 0.93, 95% confidence interval 0.75-1.16, P = 0.52) or medical complications (odds ratio 0.87, 95% confidence interval 0.59-1.26, P = 0.46).

CONCLUSIONS

The use of ADM in DTI breast reconstruction is not associated with a higher risk of short-term complications, supporting its continued use in clinical practice. This information is crucial for surgeons and patients in making informed decisions regarding the incorporation of ADM in DTI breast reconstruction.

Efficacy and Safety of Low Molecular Weight Heparin and Mechanical Thromboprophylaxis in Immediate Implant-based Breast Reconstruction: A Retrospective Comparative Analysis

BACKGROUND/AIM

Low molecular weight heparin (LMWH) is widely employed to prevent postoperative venous thromboembolism (VTE). This study aimed at analyzing LMWH use and evaluating its efficacy and safety in immediate implant-based post-mastectomy breast reconstruction.

PATIENTS AND METHODS

A monocentric retrospective analysis was conducted on patients who underwent immediate implant-based breast reconstruction (IBR) from January 2021 to December 2023. Preoperative characteristics, Caprini score, type of mastectomy procedure, administration of LMWH, postoperative outcomes, and any adverse events linked to LMWH usage, with particular attention to hematoma or VTE, were collected and analyzed.

RESULTS

A total of 211 breast procedures were performed on 179 patients - with a mean age of 50.9 years (SD 12.3) and a mean Caprini score of 6.8 (SD 1.4). In total, 133 patients received LMWH by subcutaneous injection (enoxaparin 40 mg/day) post-operatively and 46 only had mechanical thromboprophylaxis. The overall complication rate was higher but statistically significant in the LMWH group with 27.8% compared to 17.4% in the no-LMWH group (p=0.159). Hematoma occurred in 17 patients (12.8%) in the LMWH group compared to two (4.4%) patients in the no-LMWH group (p=0.164). Moreover, 15 (11.2%) patients who received LMWH required reoperation compared to one (2.2%) in patients who did not receive LMWH (p=0.074). There were no VTE events in either group.

CONCLUSION

There were no significant differences in complications and especially hematoma rate in patients who received LMWH after mastectomy and immediate IBR, compared to patients who did not. Moreover, no difference in VTE rate was observed across groups.

Protein as a preoperative predictor - Impact of hypoalbuminemia on 30-day outcomes of breast reduction surgery

BACKGROUND

Hypoalbuminemia, a biomarker of malnutrition, has been associated with adverse surgical outcomes;, however, its impact on breast reduction surgery is not yet well-documented.

METHODS

We queried the American college of surgeons national surgical quality improvement program database to identify patients who underwent breast reduction surgery between 2008 and 2022. Patients were grouped by preoperative normal albumin levels (≥3.5 g/dL) and hypoalbuminemia (<3.5 g/dL). Preoperative, intraoperative, and 30-day postoperative outcomes, including complications and readmissions, were compared using the univariate tests and multivariable logistic regression.

RESULTS

We included a total of 7277 cases, among whom 96% (n = 6964) had normal albumin values and 4% (n = 298) had hypoalbuminemia (n = 298). Patients with hypoalbuminemia showed a significantly higher body mass index (37.1 ± 8.1 vs. 33.3 ± 6.3 kg/m², p < 0.001) and were more likely to be Black or African American (49.0 vs. 27.8%, p < 0.001). Comorbidities such as diabetes (14.7 vs. 7.4%, p < 0.001), chronic obstructive pulmonary disease (4.0 vs. 1.0%, p < 0.001), and hypertension (35.2 vs. 26.3%, p = 0.002) were significantly more prevalent in the hypoalbuminemia group. Hypoalbuminemia was associated with a significantly increased risk of complications (13.8 vs. 6.1%, p < 0.001), with higher rates of superficial incisional infections (7.0 vs. 2.6%, p = 0.001) and unplanned readmissions (3.4 vs. 1.4%, p = 0.05). Multivariable analysis confirmed hypoalbuminemia as an independent predictor of postoperative complications (OR 1.96, p = 0.001), medical complications (OR 2.62, p = 0.02), and surgical complications (OR 1.91, p = 0.02).

CONCLUSION

Hypoalbuminemia significantly raises the risk of 30-day postoperative complications in breast reduction surgery. Preoperative nutritional assessment and optimization are crucial in improving surgical outcomes, particularly in patients with high body mass index and comorbidities.

Surgical Management of Breast Capsular Contracture-A Multi-institutional Data Analysis of Risk Factors for Early Complications

BACKGROUND

Capsular contracture (CC) is a common complication following implant-based breast surgery, often requiring surgical intervention. Yet, little is known about risk factors and outcomes following CC surgery.

METHODS

We reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2008-2021) to identify female patients diagnosed with CC and treated surgically. Outcomes of interest included the incidence of surgical and medical complications at 30-days, reoperations, and readmissions. Confounder-adjusted multivariable analyses were performed to establish risk factors.

RESULTS

5,057 patients with CC were identified (mean age: 55 ± 12 years and mean body mass index [BMI]: 26 ± 6 kg/m2). While 2,841 (65%) women underwent capsulectomy, capsulotomy was performed in 742 patients (15%). Implant removal and replacement were recorded in 1,160 (23%) and 315 (6.2%) cases, respectively. 319 (6.3%) patients experienced postoperative complications, with 155 (3.1%) reoperations and 99 (2.0%) readmissions. While surgical adverse events were recorded in 139 (2.7%) cases, 86 (1.7%) medical complications occurred during the 30 day follow-up. In multivariate analyses, increased BMI (OR: 1.04; p = 0.009), preoperative diagnosis of hypertension (OR: 1.48; p = 0.004), and inpatient setting (OR: 4.15; p < 0.001) were identified as risk factors of complication occurrence.

CONCLUSION

Based on 14 years of multi-institutional data, we calculated a net 30 day complication rate of 6.3% after the surgical treatment of CC. We identified higher BMI, hypertension, and inpatient setting as independent risk factors of postoperative complications. Plastic surgeons may wish to integrate these findings into their perioperative workflows, thus optimizing patient counseling and determining candidates' eligibility for CC surgery.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Assessing Donor Site Morbidity and Impact on Quality of Life in Free Flap Microsurgery: An Overview

Donor site morbidity remains a significant concern in free flap microsurgery, with implications that extend beyond immediate postoperative outcomes to affect patients' long-term quality of life. This review explores the multi-faceted impact of donor site morbidity on physical, psychological, social, and occupational well-being, synthesizing findings from the existing literature. Particular attention is given to the functional limitations, sensory deficits, aesthetic outcomes, and chronic pain associated with commonly utilized free flaps. Advancements in surgical techniques, including nerve-sparing and muscle-sparing methods, as well as innovations, like perforator flaps, have demonstrated the potential to mitigate these morbidities. Furthermore, the integration of regenerative medicine strategies, such as stem cell therapy and fat grafting, and technological innovations, including virtual reality rehabilitation and biofeedback devices, has shown promise in enhancing recovery and minimizing long-term complications. Despite these advances, challenges persist in standardizing QoL assessments and optimizing donor site management. This review emphasizes the need for a holistic, patient-centered approach in reconstructive microsurgery, advocating for further research to refine current strategies, improve long-term outcomes, and develop robust tools for QoL evaluation. By addressing these gaps, reconstructive surgeons can better align surgical objectives with the comprehensive well-being of their patients.

Preventive Paradox? Postoperative Outcomes After Risk-Reducing Mastectomy and Direct-to-Implant Breast Reconstruction

BACKGROUND

Risk-reducing mastectomy (RRM) with direct-to-implant (DTI) breast reconstruction is becoming increasingly important in breast cancer prevention. While the oncological benefits of RRM-DTI are well documented, there is a paucity of studies investigating its perioperative safety.

METHODS

The ACS-NSQIP database (2008-2022) was queried to identify all patients who underwent RRM-DTI. Outcomes of interest included 30-day occurrence of reoperation, readmission, and surgical and medical complications. Multivariate logistic regression was used to determine factors associated with postoperative complications.

RESULTS

A total of 1019 patients were included, with a mean age and BMI of 42.8 ± 10.9 years and 25.7 ± 5.8 kg/m², respectively. Complications occurred in 142 (14.0%) cases, with 103 (10.1%) reoperations and 51 (5.0%) readmissions. 62 (6.3%) surgical complications were recorded, the majority of which were superficial incisional infection (n = 19; 1.9%) and organ space infections (n = 19; 1.9%). Medical complications were rare (n = 13; 1.3%). Multivariable analyses revealed that higher BMI was significantly associated with any (OR:1.06, P < .0001), surgical (OR:1.08, P < .0001), and medical complications (OR:1.08, P = .04). Patients with bleeding disorders were at a significantly higher risk of any complications (OR:5.5, P = .03), while outpatient setting (OR:1.9, P = .03) and corticosteroid use (OR:6.6, P = .01) were identified as independent predictors of surgical complications.

CONCLUSION

The risk of adverse events following RRM-DTI should not be underestimated, with a 30-day complication rate of 14%. Higher BMI, bleeding disorders, outpatient setting, and corticosteroid use were identified as risk factors. These findings underscore the need for thorough preoperative risk stratification, patient counseling, and health optimization to optimize surgical outcomes.

Gynecomastia Surgery in 4996 Male Patients Over 14 Years: A Retrospective Analysis of Surgical Trends, Predictive Risk Factors, and Short-Term Outcomes

BACKGROUND

The high prevalence of benign male breast tissue enlargement (gynecomastia) has resulted in a marked increase of gynecomastia cases. While about one third of male adults experience some form of gynecomastia, gynecomastia surgery (GS) outcome research is limited to small study populations and single-center/-surgeon databases. In this study, we aimed to access the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify preoperative risk factors for complications and investigate postoperative outcomes of GS.

METHODS

In this retrospective study, we queried the ACS-NSQIP database from 2008 to 2021 to identify male adult patients who underwent GS. Postoperative outcomes involved the occurrence of any, surgical and medical complications, as well as reoperation, readmission, and mortality within a 30-day postoperative time period. Univariable and multivariable assessment were performed to identify risk factors for complications while adjusting for possible confounders.

RESULTS

The study included 4,996 GS patients with a mean age of 33.7 ± 15 years and BMI of 28.2 ± 5.1 kg/m2. White patients constituted 54% (n = 2713) of the cohort, and 27% (n = 1346) were obese. Except for 2020, there was a steady increase in GS cases over the study period. Outpatient surgeries were most common at 95% (n = 4730), while general surgeons performed the majority of GS (n = 3580; 72%). Postoperatively, 91% (n = 4538) of patients were discharged home; 4.4% (n = 222) experienced any complications. Multivariable analysis identified inpatient setting (p < 0.001), BMI (p = 0.023), prior sepsis (p = 0.018), and bleeding disorders (p = 0.047) as independent risk factors for complications.

CONCLUSION

In this study, we analyzed 4996 male adult GS patients from the ACS-NSQIP database, revealing an increased caseload and significant general surgeon involvement. Risk factors like bleeding disorders, inpatient status, and prior sepsis were linked to postoperative complications, while BMI was crucial for predicting adverse events. Overall, our findings may aid in enhancing patient care through advanced preoperative screening and closer perioperative management.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The impact of age on outcomes after breast reduction surgery - A multi-institutional data analysis of 40,958 cases

BACKGROUND

Reduction mammoplasty is popular among people of various age groups, yet the impact of age on postoperative outcomes remains debated.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program (2008-2021) was queried to identify adult female patients who underwent reduction mammoplasty. Patients were categorized into 10-year age brackets (i.e., 18-29, 30-39, 40-49, 50-59, 60-69, and >70 years). We compared age-dependent 30-day outcomes via confounder-adjusted multivariate analyses.

RESULTS

40,958 female patients (mean age: 41 ± 14 years and mean body mass index: 31 ± 6.1 kg/m²) were identified. Complications occurred in 6.4% (n = 2635) of cases, with 770 (1.9%) and 483 (1.2%) patients requiring reoperation and readmission, respectively. 1706 (4.2%) women experienced surgical complications, whereas medical complications were generally rare (n = 289; 0.7%). Compared with women aged 18-29 years, risks of any, surgical, and medical complications were higher for patients aged 30-39 years (OR: 1.22, p < 0.01; OR: 1.05, p = 0.51; OR: 1.84, p < 0.01), 40-49 years (OR: 1.34, p < 0.01; OR: 1.17, p = 0.04; OR: 1.54, p = 0.03), 50-59 years (OR: 1.45, p < 0.01; OR: 1.31, p < 0.01; OR: 1.78, p < 0.01), 60-69 years (OR: 1.38 years, p < 0.01; OR: 1.29, p = 0.01; OR: 1.71, p < 0.01), and >70 years (OR: 1.25, p = 0.18; OR: 1.01, p = 0.98; OR: 1.86, p = 0.14). Patients aged >30 years were also more likely to require readmissions and reoperations.

CONCLUSION

Patient age significantly affects outcomes after reduction mammoplasty, with the lowest risk in patients aged <30 years. Importantly, the association between age and postoperative morbidity was not linear. These findings can help guide informed decisions, recognizing that while age is a factor, it is not the sole determinant of risk.

Disaggregation of Asian American, Native Hawaiian, and Pacific Islander populations in postmastectomy breast reconstruction

PURPOSE

Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patient populations are often defined as one monolithic group in medical research despite cultural, socioeconomic, and clinical heterogeneity. Although the general AANHPI population is underrepresented in reception of postmastectomy breast reconstruction, existing literature has not characterized the disaggregation of such rates for AANHPI ethnic subgroups.

METHODS

Patients who underwent mastectomy were identified in the 2007 to 2020 registries within the Surveillance, Epidemiology and End Results database. Patients were stratified by race and ethnicity, and additional demographic and oncologic variables were collected. Multivariate binary logistic regression was conducted to assess for reception of postmastectomy immediate breast reconstruction (p < 0.05).

RESULTS

Among 33,422 AANHPI patients who underwent mastectomy, South Asian patients were associated with the highest breast reconstruction rates (33%) and Melanesians with the lowest (15%). Overall, AANHPI patients were associated with a lower breast reconstruction rate than non-Hispanic Whites (27% vs. 35%; p < 0.001). This difference increased from 6.4% in 2007 to 10% in 2020. After controlling for demographic and oncologic covariates, all AANHPI ethnic subgroups predicted a lower likelihood of breast reconstruction than non-Hispanic Whites (p < 0.001). Odds ratios for reconstruction ranged from 0.17 [95% confidence interval (95% CI), 0.11-0.27] for Melanesian patients to 0.45 (95% CI, 0.42-0.48) for South Asian patients.

CONCLUSIONS

Disparities in the receipt of immediate breast reconstruction exist within the AANHPI patient population in the United States. This analysis supported the need for disaggregation in plastic surgery research for improved knowledge and targeted interventions.

Quality of life and satisfaction after breast augmentation: A systematic review and meta-analysis of Breast-Q patient-reported outcomes

BACKGROUND

Breast augmentation ranks among the most popular plastic surgery procedures. Yet, reports on post-operative patient-reported quality of life (QoL) and satisfaction remain conflicting.

METHODS

A systematic review was conducted following the PRISMA guidelines. Three databases were searched for eligible studies that reported pre-and/or post-operative Breast-Q™ augmentation scores for patient QoL (psychosocial, sexual, and physical well-being) and/or satisfaction.

RESULTS

A total of 39 studies (53 patient cohorts and 18,322 patients) were included in the quantitative synthesis. The pairwise meta-analysis revealed significant improvements in patient-reported psychosocial (MD: +38.10) and sexual well-being (MD: +40.20) as well as satisfaction with breast (MD: +47.88) (all p < 0.00001). Physical well-being improved slightly after breast augmentation (MD: +6.97; p = 0.42). The single-arm meta-analysis yielded comparable results, with Breast-Q™ scores in psychosocial and sexual well-being as well as satisfaction with breast increasing from 37.2, 31.1, and 26.3 to 75.0, 70.6, and 72.7, respectively (all p < 0.00001). Physical well-being improved by 8.1 (75.8 pre-operatively to 83.9 post-operatively; p = 0.17). Subgroup analyses highlighted higher QoL and satisfaction following breast augmentation for purely esthetic purposes and alloplastic mammaplasty. Although patient-reported physical and sexual well-being increased in the long term, psychosocial well-being was the highest in the short term.

CONCLUSION

Patient satisfaction with breast, psychosocial, and sexual well-being increased significantly after breast augmentation. In contrast, patient-reported physical well-being yielded ambivalent results, varying by mammaplasty technique and post-operative follow-up time. Plastic surgeons should be sensitized about our findings to refine eligibility criteria and gain a deeper understanding of the patients' perceived surgical experience.

PROSPERO TRIAL REGISTRATION NO

CRD42023409605.