D94. Reconstructing Failure: Assessing Surgical and Patient Reported Outcomes Following Loss of Initial Breast Reconstruction

PURPOSE: Reconstructive loss is uncommon but challenging and distressing to patients. We aimed to describe the post-loss progression of patients who experience reconstructive failure, assess which patients are more likely to undergo additional reconstruction, and compare BREAST-Q scores between those who undergo additional reconstruction versus those who do not. METHODS: Patients who underwent TE, implant, and autologous breast reconstruction between 2017 and September 2022 were included. Reconstructive failure was defined as removal of prosthetic devices or flap without replacement. Patients without at least 1-year follow-up after failure were excluded. RESULTS: 6,002 patients underwent TE, implant, and/or autologous reconstruction. Of the 4,252 TE patients, 285(6.7%) patients had TE loss. 139(48.8%) patients had additional reconstruction, half of whom converted to an autologous reconstruction. 4,457 patients had implants placed, and 63(1.4%) experienced implant loss. Majority of these patients (95.2%) did not have another reconstruction. Of the 1,545 autologous reconstruction patients, 16(1.0%) experienced total flap loss; 9(56.2%) patients underwent additional reconstruction.Of the 364 reconstructive failure patients, 151 (41.5%) underwent additional breast reconstruction. Younger age (OR=1.05), psychiatric diagnosis (OR=1.91), and nipple-sparing mastectomy (OR=4.01) were significantly associated with increased likelihood of undergoing another reconstruction. Although not statistically significant, patients who underwent additional reconstruction trended towards having higher Psychosocial Well-being (62[IQR: 56,80] versus 50[44,61]) and Sexual Well-being (48[36,58] vs 27[17,47]) than those who did not. CONCLUSION: Less than half of patients who experience reconstructive failure undergo another reconstruction. Our findings suggest that patients may benefit from counseling about further reconstruction as those with additional reconstruction may have higher BREAST-Q scores.