The effect of an urban vs. rural environment on outcomes in autologous breast reconstruction: A single center matched cohort study.

[INTRODUCTION] Increasing access to autologous breast reconstruction requires significant outreach efforts. We have made focused efforts in care coordination, addition of physician extenders, outreach clinics, and telehealth utilization to improve access and outcomes for all patients. The impact in high population urban settings compared to rural settings has not been determined.

[METHODS] A retrospective review of patients who underwent free flap breast reconstruction at a single center between 2017 and 2022 was performed. Rural and urban cohorts were created using the Rural-Urban Commuting Area (RUCA) system, based on population density, urbanization, and daily commuting. Propensity score matching was then used to control for reconstruction type, timing, oncologic stage, chemotherapy, radiation, age, BMI, smoking status, T2DM, HTN, cardiovascular disease, and autoimmune disease.

[RESULTS] 45 patients each met the inclusion criteria for rural and urban cohorts, producing 32 matched pairs. The groups had significant differences in zip code median household income ($65,418 urban vs. $46,825 rural, p<0.01), and zip code bachelor's degree education level (25.5% urban vs. 13.6% rural, p< 0.01). However, surgical outcomes were similar between groups with respect to mastectomy skin flap necrosis, recipient site infection, recipient site wound, breast revisions, donor site infection, donor site wound, seroma, donor site revisions, fat necrosis, hernia/bulge, length of follow-up, or drain removal time.

[CONCLUSION] This study shows that patients in both urban and rural settings can have similar outcomes in autologous breast reconstruction when resources are applied to improve access, education, and communication.