Complications of Breast Reconstruction: Does the Area Deprivation Index Predict Risk?

INTRODUCTION: Despite mandated post-mastectomy reconstruction coverage since the Women’s Health and Cancer Rights Act (1998), vulnerable populations may be prone to breast reconstruction complications. The Area Deprivation Index (ADI) reflects neighborhood socioeconomic status utilizing US census data. This study investigates ADI's relationship to breast reconstruction complications.METHODS: A retrospective study of immediate pre-pectoral direct-to-implant reconstruction patients at a metropolitan healthcare system from 2018-2022 was conducted. Patients were stratified by ADI: <50th percentile (ADI=1-5) and ≥50th percentile (ADI=6-10). Demographics, medical history, treatment history, and postoperative outcomes were compared. Descriptive statistics identified differences between ADI groups. Minor complications were defined as incidence of hematoma, seroma, superficial wounds, full thickness necrosis, or oral antibiotic-treated cellulitis. Major complications were defined as incidence of hospital readmission or return to OR. Long-term complications were defined as incidence of capsular contracture or ≥3 revisions. Logistic regression assessed ADI’s predictive value, accounting for confounds between cohorts.RESULTS: Of 195 patients, 147 had low ADI and 48 had high ADI. Significant differences in BMI and race were found between groups. Low ADI demonstrated higher BMI (p<0.01) and black patient representation (p<0.01). No differences were found for any complications.CONCLUSIONS: Contradictory to the literature highlighting greater surgical complication rates in low ADI patients, our results show comparable outcomes to high ADI patients. Our multidisciplinary breast cancer program delivers high quality standardized care with early plastic surgeon consultation and patient education throughout multiple hospital systems with racial, ethnic, and socioeconomic diversity. Education, support, and access are provided equally regardless of ADI.