The Impact of Travel Distance on Patient Outcomes after Breast Reconstruction.

Background: Geographical barriers can impact access to healthcare, but their influence on complications and long-term patient-reported outcomes (PROs) after breast reconstruction is unclear. This study evaluates the impact of travel distance on postoperative complications and PROs using the BREAST-Q.

Patients And Methods: Patients who underwent postmastectomy breast reconstruction between 2017 and 2023 were categorized by travel distance into five groups (0-10, 11-25, 26-50, 51-100, 101+ miles). Complications assessed included wound infection, delayed wound healing, hematoma, mastectomy skin flap necrosis, and seroma. BREAST-Q domains-physical well-being of the chest (PWBC), psychosocial well-being (PSWB), satisfaction with breasts (SATSB), and sexual well-being (SWB)-were evaluated, when available, preoperatively and at 6 months and 1, 2, 3, 4, and 5 years. Linear mixed-effects (LME) modeling assessed travel distance as an independent predictor of PROs.

Results: Among 5600 patients (4202 implant, 1398 autologous), wound infection rates differed significantly by travel distance in the implant cohort (p = 0.005), but other complications were consistent across groups. PROs were similar across travel distance groups for PWBC, PSWB, and SWB domains at all timepoints. SATSB scores varied significantly by travel distance at 1 years (p = 0.031), and 2 years (p = 0.008) postoperatively. LME modeling revealed minimal association between travel distance and PROs. Patients traveling 11-25 miles reported slightly higher SWB scores (p = 0.045) than those traveling 0-10 miles, but differences did not meet the minimally clinically important difference of 4 points.

Conclusions: Travel distance did not meaningfully influence clinical outcomes or PROs, confirming patients can safely travel to specialized centers for breast reconstruction without compromising care or well-being.