P4. The Continuum of Care in Autologous Breast Reconstruction: A Longitudinal Assessment of Revisional Procedures in 4,896 Free Flaps

PURPOSE: To examine breast aesthetic revisions (AR) following free flap autologous breast reconstruction (FFABR) and identify factors associated with these procedures. METHODS: Using a prospectively maintained health-system wide registry, patients undergoing immediate and delayed FFABR following mastectomy from 2008-2020 were identified. ARs encompassed scar revisions, fat grafting, liposuction, dog ear excision, reduction mammaplasty, mastopexy, local tissue rearrangement and implant-related changes. Using survival analysis and Cox regression modeling, we discerned patient and operative factors associated with AR. RESULTS: From 3,057 patients with 4,896 free flaps were followed up for a median of 4.3 years, 75.1% were bilateral, and most were muscle-sparing TRAM (66.9%) and DIEP (26.9). The median age was 51 years old (IQR, 44-59), 72.1% of patients were non-Hispanic White, with a median BMI of 28.2 (IQR 24.7-32.4). A total of 2,538 flaps required AR (51.8%), and the median time to first and last revisions were 320 and 479 days. The most common ARs were fat grafting (35.4%) and local tissue rearrangement (29%) for contour- (60.4%) and volume-related (31%) reasons. Factors independently associated with increased risk for AR included White race, younger age, non-abdominally based free flaps, adjuvant chemotherapy or radiotherapy, and postoperative complication within 90 days (all p<0.01). CONCLUSIONs: Roughly half of free flaps require ARs post-FFABR, predominantly within two years. Factors like race, flap type, and complications significantly impact AR rates. This information aids in setting patient expectations and understanding the FFABR timeline.