D120. Outcomes in Immediate, Delayed-Immediate, and Delayed Autologous Breast Reconstruction: A Fourteen-year National Database Analysis

PURPOSE: There exists a lack of consensus regarding optimal timing and modality of autologous breast reconstruction (ABR). This study compares postoperative outcomes among patients undergoing immediate, delayed-immediate, and delayed ABR. METHODS: Using the MerativeTM MarketScan® Research Databases, 2007-2021, adult female breast cancer patients undergoing mastectomy with concurrent or subsequent ABR were identified and stratified by ABR modality. Demographics, timing of adjuvant radiotherapy, and postoperative outcomes were recorded. Univariate testing and multivariate regression modeling were performed. RESULTS: Of 19,805 patients (mean age 50.20±8.11 years), 65% underwent immediate reconstruction and 29% underwent delayed reconstruction. The immediate cohort, when compared to delayed-immediate and delayed, more frequently experienced post-mastectomy tissue necrosis (7% vs. 5% and 4%; p<0.001), deep vein thrombosis/vascular complications (3% vs. 2% and 1%; p<0.001), and hematoma/hemorrhage (5% vs. 2% and 3%; p<0.001). Infection rates were higher in delayed-immediate (9%) than in immediate (7%) and delayed (7%)(p=0.005). Seroma was more prevalent in delayed reconstruction (7%) than in delayed-immediate (5%)(p=0.001). Notably, postmastectomy lymphedema syndrome (PMLS) was far less prevalent in immediate reconstruction (11%) than in the delayed-immediate (24%) and delayed (21%)(p<0.001). CONCLUSION: Necrosis, vascular complication, and hematoma rates were highest for immediate reconstructions, while infection rates were highest for delayed- immediate. Patients undergoing immediate reconstruction were less likely to experience PMLS. Considering patient age, comorbidities, and radiation timing better informs multifactorial decision-making surrounding reconstruction modalities to optimize outcomes.