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A Longitudinal (10 Year) Assessment of Abdominal Wall Strength and Health after Autologous Breast Reconstruction
Jonas A. Nelson, MD1, Michael G. Tecce, BS1, Michael A. Lanni, BS1, Jesse C. Selber, MD2, Lisa C. Wu, MD1, Joseph M. Serletti, MD1.
1University of Pennsylvania, Philadelphia, PA, USA, 2The University of Texas, Houston, TX, USA.

PURPOSE:
The purpose of this study is to provide long-term, subjective and objective functional data on patients undergoing autologous breast reconstruction using abdominal tissue and to assess factors impacting functional differences.
METHODS:
Patients participated in this prospective study between 2005 and 2015, completing preoperative, early and late subjective and objective evaluations. Objective examination included an assessment of upper (UA) and lower (LA) abdominal strength and functional independence (FIM). Patient reported outcomes (PROs) included the Short Form 36 (SF36) and the Breast Q. Scores were compared by laterality and flap type, and a logistic regression was performed to determine factors influencing function.
RESULTS:
Fifty-one patients completed long-term follow-up, averaging 6.9 years (range 5-10). Overall, 78.8% of patients had stable or improved scores across the UA, LA and FIM, with no significant differences based upon laterality or flap types (Table 1). Subjectively, 90% demonstrated improvement in SF36 physical health component. Obesity and comorbid conditions were risk factors for scoring in the lowest third of SF36 physical health component scores (p=.012). Further, obesity was determined to negatively impact both the mental (p<.005) and the physical (p<.001) components as well as change in mental health score (p<.026).
CONCLUSION:
Abdominally based autologous breast reconstruction does not appear to cause long term strength or functional impairment. However, obese patients may be at risk for long-term subjective physical and mental health impairment.
Table 1: Statistical analysis results (p-values) for comparisons of abdominal wall function
ComparisonUnilateral vs. BilateralUnilateral flap typeBilateral flap typeObese vs. Non-obese
Δ Upper Abdominal Strength0.0980.940.230.07
Δ Lower Abdominal Strength0.190.870.590.11
SF36 Physical Health0.900.470.17<0.001
Change in Physical Health0.500.410.230.002
SF36 Mental Health0.750.890.240.005
Change in Mental Health0.340.360.330.03
Breast Q Abdominal Well-being0.490.230.530.15


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