SP57. Going The Distance: Travel Distance Does Not Compromise Long-term Breast Reconstruction Patient Satisfaction and Quality of Life

PURPOSE: Geographical barriers, such as travel distance, can influence access to healthcare and surgical outcomes. While some studies have explored the relationship between travel distance and the type of breast reconstruction obtained, the specific impact of travel distance on long-term patient-reported outcomes (PROs) remains unclear. This study evaluates the impact of travel distance on long-term PROs following breast reconstruction using the BREAST-Q. METHODS: A retrospective review was conducted on patients who underwent implant-based and autologous breast reconstruction between January 2017 and December 2023 at Memorial Sloan Kettering Cancer Center (MSKCC). Travel distance was calculated from the distance between a patient’s home ZIP code to MSKCC and categorized into five groups: 0-10 miles, 11-25 miles, 26-50 miles, 51-100 miles, and over 100 miles. PROs were assessed using the BREAST-Q at preoperative, 6-month, 1-year, 2-year, 3-year, and 4-year time points. The BREAST-Q domains analyzed included physical well-being of the chest (PWBC), psychosocial well-being (PSWB), satisfaction with breasts (SATB), and sexual well-being (SEX). Associations between travel distance and PROs were assessed using the Kruskal-Wallis test. Multivariable linear mixed-effects models of PROs over time adjusted for clinical and demographic covariates, and clinically meaningful changes were evaluated using the minimally clinically important difference (MCID) of 4. RESULTS: A total of 5,600 patients (4,202 implant; 1,398 autologous) were included. Patients were distributed across travel distance categories as follows: 1,444 patients in the 0-10 miles group, 2,048 in the 11-25 miles group, 1,081 in the 26-50 miles group, 546 in the 51-100 miles group, and 481 in the 101+ miles group. On univariate analysis, SATB varied significantly across travel distances, with patients traveling over 101 miles reporting higher satisfaction than those traveling shorter distances at both 1 year (58 [49, 37] vs. 62 [53, 75] vs. 62 [51, 75] vs. 61 [49, 75] vs. 64 [53, 73]; p=0.031) and 2 years (59 [48, 71] vs. 62 [53, 75] vs. 62 [52, 75] vs. 62 [51, 75] vs. 64 [54, 75]; p=0.008). The MCID was met when comparing patients who traveled more than those who traveled 0-10 miles at both time points. Univariate analysis showed no statistical differences in BREAST-Q scores across all other domains assessed. On multivariable analysis, patients traveling 11-25 miles demonstrated higher SEX scores than those traveling 0-10 miles (Beta=1.5, p=0.041). However, the MCID was not met for the SEX domain or any other BREAST-Q domains assessed. CONCLUSIONS: Travel distance did not meaningfully impact PROs across BREAST-Q domains. Regardless of travel distance, patients reported similar satisfaction levels with their reconstruction and overall well-being. These findings suggest that patients can confidently pursue breast reconstruction at specialized centers, even when located farther from home, with minimal or no compromise on patient outcomes.