Assessing the Impact of Frailty on Patient-Reported Outcomes and Clinical Complications in Two-Stage Implant-Based Breast Reconstruction.

Background: The 5-item modified frailty index (5-mFI) is used to predict clinical outcomes in breast reconstruction, but its relationship to patient-reported outcomes (PROs) after two-stage implant-based reconstruction (IBR) is unclear. This study evaluates how frailty is associated with clinical outcomes and PROs using the BREAST-Q. We hypothesized that higher 5-mFI scores would correlate with poorer outcomes and PROs.

Methods: Patients aged ≥18 who underwent immediate two-stage IBR (January 2017-April 2023) were included. Complications (e.g., reconstructive failure, salvage, cellulitis/infection, seroma, mastectomy skin flap necrosis) and BREAST-Q scores for Sexual Well-being (SEX), Psychosocial Well-being (PWB), Satisfaction with Breasts (SWB), and Physical Well-being of the Chest (PWBC) were compared between low frailty (5-mFI <2) and high frailty (5-mFI ≥2) groups at baseline, 6 months, 1 year, and 2 years post-exchange.

Results: Of 2,697 patients, 95% (n=2,569) were low frailty. Seroma rates differed significantly between frailty cohorts, but frailty status was not associated with complications on multivariable analysis. High frailty patients reported significantly lower SWB preoperatively and at 2 years. Low frailty patients consistently had better PWBC scores than high frailty patients. PWB and SEX scores were significantly higher in low frailty patients preoperatively and at 6 months. Multivariable analysis confirmed increased frailty was associated with lower PWBC scores.

Conclusions: While the 5-mFI has does not effectively predict outcomes for all aspects of the BREAST-Q, it may be useful for predicting PWBC for patients undergoing two-stage IBR. Furthermore, it may not be an effective metric to predict IBR postoperative complications.