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Outcomes of Free Flap Breast Reconstruction at Academic vs Non-Academic Centers.
Alan T. Makhoul
*, Said Azoury
Plastic Surgery, University of Pennsylvania, Philadelphia, PA
Background: Free flap breast reconstruction is increasingly being practiced in non-academic settings. The outcomes of free tissue transfer in academic and non-academic settings have not been adequately compared.
Methods: The TriNetX USA Research Network, a de-identified database containing records from 67 healthcare organizations, was queried using CPT code 19364 to identify patients who underwent free flap breast reconstruction at an academic or non-academic medical center between 2011-2025. Propensity score matching (1:1, nearest-neighbor) was performed to create two balanced cohorts controlling for age, race, BMI, tobacco history, type II diabetes history, tumor node metastasis (TNM) classification, and radiation history. Three-year post-operative outcomes were evaluated via CPT and ICD-10 codes and compared using odds ratios with 95% confidence intervals.
Results: 114,652,735 records were queried, yielding 7,965 patients treated at an academic center and 829 patients treated at a non-academic center. Post-matching, characteristics were similar between the academic (n = 814) and non-academic (n = 814) cohorts. No differences in free flap complication rates were observed, including flap failure, hematoma, seroma, fluid collection drainage, dehiscence, infection, or operative debridement (Table 1). Post-operative atelectasis was more common in the academic cohort (OR 1.67, CI 1.10-2.52, p = .014), and incisional hernia was more common in the non-academic cohort (OR .532, CI .302-.938, p = .027). No differences in pneumonia, deep vein thrombosis, pulmonary embolism, urinary tract infection, kidney failure, or sepsis rates were observed.
Conclusion: Outcomes of free flap breast reconstruction are similar between academic and non-academic settings. Performing free tissue transfer without trainee involvement or the resources of an academic center does not negatively impact patient or flap outcomes. Post-operative hernia was more common among patients treated at a non-academic center, suggesting differing approaches to donor site management.
Three-Year Post-Operative Outcomes.
| | Academic,
n (%) | Non-academic,
n (%) | Odds Ratio
(95% CI, P-value) |
| N | 814 | 814 | |
| Flap outcomes | | | |
| Flap failure | 17 (2.09) | 11 (1.35) | 1.56 (.725-3.35, .253) |
| Seroma | 33 (4.05) | 31 (3.81) | 1.07 (.647-1.76, .799) |
| Hematoma | 13 (1.60) | 23 (2.83) | .558 (.281-1.11, .092) |
| Collection drainage | 30 (3.29) | 40 (4.91) | .740 (.456-1.20, .221) |
| Dehiscence | 105 (12.9) | 103 (12.7) | 1.02 (.764-1.37, .882) |
| Infection | 71 (8.72) | 80 (9.83) | .877 (.627-1.23, .442) |
| Operative debridement | 59 (7.25) | 56 (6.88) | 1.06 (.724-1.55, .771) |
| Incisional hernia | 19 (2.33) | 35 (4.30) | .532 (.302-.938, .027)* |
| Patient outcomes | | | |
| Atelectasis | 63 (7.74) | 39 (4.79) | 1.67 (1.10-2.52, .014)* |
| Pneumonia | 21 (2.58) | 25 (3.07) | .836 (.464-1.51, .550) |
| Deep vein thrombosis | 28 (3.44) | 21 (2.58) | 1.34 (.755-2.39, .314) |
| Pulmonary embolism | 15 (1.84) | 13 (1.60) | 1.16 (.548-2.45, .698) |
| Urinary tract infection | 27 (3.32) | 39 (4.79) | .644 (.390-1.06, .083) |
| Sepsis | 16 (1.97) | 27 (3.32) | .584 (.312-1.09, .089) |
| Kidney failure | 21 (2.58) | 19 (2.33) | 1.11 (.591-2.08, .749) |
CI, confidence interval. Cell counts fewer than 10 were suppressed in accordance with TriNetX data privacy requirements; p-values for these comparisons were therefore not available. Statistically significant p-values are shown with an asterisk.
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