Health literacy is closely linked to health outcomes, underscoring the importance of accessible patient education, particularly for patients undergoing complex surgical procedures. Despite this, there is limited research examining the influence of health literacy on outcomes in autologous breast reconstruction.

We performed a retrospective review of autologous breast reconstruction patients between 2017 and 2022 at our institution. Baseline demographic and clinical data were collected. Health literacy scores were assessed using the validated Set of Brief Screening Questions (SBSQ), with increasing value equating lower health literacy. Patients were categorized by the Charlson Comorbidity Index (CCI) into groups representing mild, moderate, and severe comorbidity burden. Logistic and linear regression analyses were performed.

The study included 264 patients, of whom 175 had mild, 49 moderate, and 40 severe comorbidity burden. Within the severe CCI group, worse HL was associated with increased odds of recipient site wound (OR 1.85, p = 0.0472), postoperative emergency department visits within 30 days (OR 2.56, p = 0.0489), and increased postoperative phone utilization (β = 0.52, p = 0.0461). No significant association was found between health literacy scores and the rate of surgical site infections, donor site wounds, or postoperative hernia.

In this study, lower health literacy was significantly associated with increased health system utilization and wound complications in patients with severe comorbidity burden. This highlights the complex relationship between health literacy and outcomes, and the importance of patient education and shared decision-making in autologous breast reconstruction.

Received: 21 September 2025

Accepted after revision: 25 February 2026

Accepted Manuscript online:
11 March 2026

Article published online:
06 April 2026

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