SP10. Factors Associated with BREAST-Q Physical Well-being of the Chest and Abdomen following Abdominal Free Flap Breast Reconstruction

PURPOSE: The lower abdominal region is the gold standard donor site for free flap autologous breast reconstruction. A deeper understanding of factors related to physical wellbeing, however, is needed. We aimed to identify factors associated with physical well-being of the chest and abdomen in patients who underwent autologous breast reconstruction. METHODS: We conducted an examination of all patients who underwent abdominal-based free flap breast reconstruction between 2010 and 2021 who had 1-year postoperative BREAST-Q subscores, performing regression analyses to determine factors associated with physical wellbeing. RESULTS: 907 women were analyzed. For well-being of the chest, lower preoperative score (beta 0.38; p<0.001) and receipt of adjuvant or neoadjuvant radiation (vs. radiation-naïve) (beta -7.5, -3.7; p=0.002, p=0.027, respectively) were associated with lower postoperative scores at 1-year. Patients with delayed (vs. immediate) reconstruction had higher postoperative scores (beta 3.6; p<0.001). For well-being of the abdomen, lower preoperative score (beta 0.08; p=0.006), COPD (beta -3.7; p=0.037), psychiatric diagnosis (beta -6.8; p<0.001), and palpable bulge (beta -8.8; p=0.028) were associated with lower postoperative score. Compared to bilateral DIEP patients, unilateral DIEP or TRAM patients had higher postoperative scores (beta 3.7, 4.9; p=0.017, 0.047 respectively). CONCLUSION: Multiple factors influence postoperative physical wellbeing following autologous breast reconstruction, including radiation, psychiatric diagnosis, bilateral reconstruction and donor site morbidity. When counseling autologous reconstruction patients, it is important to consider the variables that may influence their long-term physical well-being of the abdomen and chest and consider physical therapy consultation in patients who have persistent postoperative challenges.