At our breast reconstruction center, we have, over time, developed a focused program to increase access to care for low-resource patients. This program includes outreach clinics, physician extenders, care coordinators, and telehealth utilization.

A retrospective review of all free flap breast reconstruction patients between 2017 and 2022 at our center was performed. Specific criteria, including insurance carrier, educational attainment, and zip code median household income, language barriers, and distance to hospital, were used to create favorably-resourced (FR) and unfavorably-resourced (UR) cohorts. Propensity score matching was then used to control for clinical factors and comorbidities.

A total of 49 and 52 patients met the inclusion criteria for FR and UR cohorts, respectively, producing 33 matched pairs. FR was associated with a greater average number of donor site revisions (0.73 vs. 0.45, p = 0.05). Other statistically significant differences included average zip code household income ($109,477 FR vs. $71,996 UR, p < 0.01), bachelor's degree education level (26% FR vs. 16% UR, p < 0.01), and average distance to hospital (25 miles FR vs. 82 miles UR, p < 0.01). No significant differences were detected between groups regarding mastectomy skin flap necrosis, recipient site infection, recipient site wound, breast revisions, donor site infection, donor site wound, seroma, fat necrosis, hernia/bulge, length of follow-up, or drain removal time.

This study shows that within a health system utilizing dedicated access to care programs, equivalent results were observed in autologous breast reconstruction among favorably and unfavorably resourced patients.

Received: 19 November 2025

Accepted after revision: 25 February 2026

Accepted Manuscript online:
09 March 2026

Article published online:
24 March 2026

© 2026. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA