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J Reconstr Microsurg
DOI: 10.1055/a-2737-6539
Original Article

Complication Burden and Demographic Trends in Autologous Breast Reconstruction Outcomes: Insights from the NIH All of Us Program

Authors

  • Hiren Parekh

    1   Yale University, New Haven, United States (Ringgold ID: RIN5755)

  • Salih Colakoglu

    2   Johns Hopkins University School of Medicine, Baltimore, United States (Ringgold ID: RIN1500)

  • sashank reddy

    3   Plastic Surgery, Johns Hopkins University, Baltimore, United States
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Background: While the risks and benefits of autologous breast reconstruction have been widely examined, nationally representative, longitudinal data on complication burden, flap utilization trends, and patient-level risk factors remain limited. The NIH All of Us Research Program provides an opportunity to address these gaps using a diverse, population-scale cohort. Methods: We identified 260 patients who underwent autologous breast reconstruction using CPT codes within the All of Us Registered Tier Dataset (1995–2025). Complications were tracked at 30 days and 1 year postoperatively. Logistic, multivariate regressions and Kaplan-Meier analyses evaluated predictors and timing of complications. Unsupervised machine learning via K-means clustering was utilized to uncover phenotypic subgroups by age and BMI. Results: DIEP flap utilization increased over time, particularly among younger patients. Complication rates did not significantly differ across flap types. BMI >32.7 kg/m² was associated with increased 30-day complications, while age and race were not independent predictors. Chronic pain and persistent postoperative pain were the most common 1-year complications. Flap failure occurred in fewer than 2% of cases. Clustering revealed three patient subgroups with distinct complication profiles; older patients and those with higher BMI experienced greater morbidity but maintained high flap success rates. Conclusion: Autologous breast reconstruction is broadly effective across diverse patient populations. Complication risk is more strongly influenced by BMI than age or race. Chronic pain emerged as a common long-term morbidity, underscoring the need for improved detection and management efforts. The diversity, depth, and follow-up available through All of Us enable nuanced insights into reconstructive outcomes not possible with traditional datasets.



Publication History

Received: 15 June 2025

Accepted after revision: 03 November 2025

Accepted Manuscript online:
06 November 2025

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