Work

86. Impact of Household Wealth on Long-term Patient-reported Outcomes Following Breast Reconstruction

Year: 2025

Type: article

Abstract: PURPOSE: Socioeconomic status (SES) is a critical factor influencing access to healthcare and outcomes. While prior studies have explored SES-related health disparities in breast reconstruction, few have focused on income’s impact on patient-reported outcomes (PROs), including long-term satisfaction and well-being. This study aims to assess the impact of household income on long-term PROs using the BREAST-Q in women undergoing implant and autologous-based breast reconstruction. METHODS: A retrospective review was conducted on patients who underwent implant and autologous breast reconstruction between January 2017 and December 2023 at Memorial Sloan Kettering Cancer Center and had insurance coverage. Household income was estimated using median income data from the U.S. Census Bureau based on patient ZIP codes. Patients were categorized into three income groups according to Pew Research Center’s brackets: low (<$61,000), medium ($61,000-$183,000), and high (>$183,000). PROs were evaluated using the BREAST-Q survey across multiple domains, including physical well-being of the chest (PWBC), psychosocial well-being (PSWB), satisfaction with breasts (SATBR), and sexual well-being (SEX) at pre-operative, 6-month, 1-year, 2-year, 3-year, and 4-year timepoints. The Kruskal-Wallis test assessed associations between income and PROs. Multivariable linear mixed-effects models were used to evaluate the impact of income on BREAST-Q scores, adjusting for clinical and demographic covariates. RESULTS: A total of 5,600 patients (4,202 implant & 1,398 autologous) met inclusion criteria. Of these, 421 patients were classified as low-income, 4,652 as middle-income, and 527 as high-income. On univariate analysis, low-income patients reported significantly lower PWBC scores at 1-year postoperatively (72 [60, 92] vs. 76 [64, 92] vs. 80 [64, 92], p=0.024). PSWB also showed disparities, with lower-income patients scoring lower at 1 year (64 [50, 87] vs. 66 [55, 83] vs. 74 [60, 87], p=0.002). SATBR followed a similar trend (58 [48, 73] vs. 61 [51, 75] vs. 64 [55, 78], p=0.011). SEX did not differ significantly at 1 year but showed differences at 2 years (48 [34, 66] vs. 50 [36, 66] vs. 56 [41, 66], p=0.04). Income disparities persisted only for PSWB after adjusting for clinical variables such as age, comorbidities, and surgical characteristics. High income was associated with improved PWBC scores (Beta=2.6; p=0.033). However, after adjusting for all factors, the Minimum Clinically Important Difference (MCID) of 4 was not met for any BREAST-Q domains. CONCLUSION: For patients undergoing breast reconstruction with insurance coverage, income does not meaningfully impact overall satisfaction and well-being when controlling for clinical and demographic factors. Although income-related differences were observed in some BREAST-Q domains, these differences did not meet the MCID after adjustment. This suggests that for insured patients, other factors—such as access to care or support services—may play a more critical role in influencing patient-reported outcomes than income alone.

Source: Plastic & Reconstructive Surgery Global Open

DOI: 10.1097/01.gox.0001112296.40497.7f