A Propensity Score-Matched Analysis of Geographic Distance in Immediate Free Flap and Implant-Based Breast Reconstruction

Background: Patient proximity to a surgical center is an important consideration of coordination and delivery of high-quality postoperative care. Implant-based and autologous breast reconstruction require different perioperative resources and may be impacted in a varying manner by distance from the health care center. This study evaluated the impact of geographic distance on clinical and financial outcomes in free flap and implant-based breast reconstruction. Methods: A retrospective review was conducted of 176 free flap and 239 implant-based immediate breast reconstructions performed from 2017–2023 at a single academic center. Patients were classified by great-circle distance to the medical center as far (≥30 miles) or near (<30 miles). Propensity score–matched cohorts were created for free flap (n=70 pairs) and implant-based (n=79 pairs) reconstruction, controlling for demographics, comorbidities, treatment variables and laterality. Clinical outcomes, wound complications, revision procedures, opioid use, hospital resource utilization, and financial measures between near and far patients for each reconstruction type were compared using paired t-tests, McNemar’s tests, and exact binomial testing for sparse outcomes. Results: In the flap cohort, near- and far-distance groups did not differ significantly in operative time, length of stay, intensive care use, postoperative communication, emergency department visits, opioid requirements, complication rates, revision procedures, or financial outcomes. Total flap loss and thromboembolic events were rare and did not differ significantly between groups. In the implant-based cohort, there were no significant differences in operative time, length of stay, postoperative communication, emergency department visits, opioid requirements, complication rates, revision procedures, or financial outcomes between groups. Conclusion: Geographic distance was not associated with worse clinical or financial outcomes after immediate breast reconstruction. These findings suggest that high-volume academic centers can deliver consistent reconstructive outcomes across a range of patient proximities.