{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:39:38Z","timestamp":1792453178589,"version":"4.5.0"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>We identified 260 patients who underwent autologous breast reconstruction using current procedural terminology codes within the All of Us Registered Tier Dataset (1995\u20132025). Complications were tracked at 30 days and 1 year postoperatively. Logistic, multivariate regressions, and Kaplan\u2013Meier analyses evaluated predictors and timing of complications. Unsupervised machine learning via k-means clustering was utilized to uncover phenotypic subgroups by age and body mass index (BMI).<\/jats:p>\n                  <jats:p>Deep inferior epigastric perforator flap utilization increased over time, particularly among younger patients. Complication rates did not significantly differ across flap types. BMI\u2009&gt;\u200932.7\u2009kg\/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.<\/jats:p>\n                  <jats:p>Autologous breast reconstruction is broadly effective across diverse patient populations. Complication risk is more strongly influenced by BMI than by 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.<\/jats:p>","DOI":"10.1055\/a-2737-6539","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:08:06Z","timestamp":1762474086000},"page":"831-842","source":"Crossref","is-referenced-by-count":3,"title":["Complication Burden and Demographic Trends in Autologous Breast Reconstruction Outcomes: Insights from the NIH All of Us Program"],"prefix":"10.1055","volume":"42","author":[{"given":"Hiren N.","family":"Parekh","sequence":"additional","affiliation":[{"name":"Yale College, Yale University, New Haven, Connecticut, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salih","family":"Colakoglu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sashank K.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"issue":"06","key":"ref1","first-page":"3846","article-title":"A review of different breast reconstruction methods","volume":"15","author":"Y Song","year":"2023","journal-title":"Am J Transl Res"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.bjps.2019.09.040","article-title":"Autologous versus implant-based breast reconstruction: a systematic review and meta-analysis of Breast-Q patient-reported outcomes","volume":"73","author":"N M Toyserkani","year":"2020","journal-title":"J Plast Reconstr Aesthet 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Hong","year":"2024","journal-title":"J Clin Med"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1177\/22925503241255118","article-title":"Donor site outcomes following autologous breast reconstruction with DIEP flap: a retrospective and prospective study in a single institution","volume":"33","author":"S Fan","year":"2024","journal-title":"Plast Surg (Oakv)"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.bjps.2019.11.039","article-title":"Autologous breast reconstruction in older women: A retrospective single-centre analysis of complications and uptake of secondary reconstructive procedures","volume":"73","author":"C I Brendler-Spaeth","year":"2020","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"1005e","DOI":"10.1097\/PRS.0000000000010487","article-title":"Introduction of the L-PAP flap: bipedicled, conjoined, and stacked 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A study of persistent postoperative pain following breast reconstruction","volume":"37","author":"R S Roth","year":"2018","journal-title":"Breast"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/SAP.0000000000003986","article-title":"Chronic pain following breast reconstruction: a scoping review","volume":"93","author":"M Shiraishi","year":"2024","journal-title":"Ann Plast Surg"},{"issue":"08","key":"ref27","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1055\/s-0040-1713174","article-title":"Racial disparities in outcomes of reconstructive breast surgery: an analysis of 51,362 patients from the ACS-NSQIP","volume":"36","author":"L L Blankensteijn","year":"2020","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1055\/a-2277-0236","article-title":"Social determinants of health and patient-reported outcomes following autologous breast reconstruction, using insurance as a proxy","volume":"41","author":"E L Plotsker","year":"2025","journal-title":"J Reconstr Microsurg"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.bjps.2023.11.016","article-title":"Applying unsupervised machine learning approaches to characterize autologous breast reconstruction patient subgroups: an NSQIP analysis of 14,274 patients","volume":"88","author":"D K Kim","year":"2024","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"10","key":"ref30","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1001\/jamasurg.2018.1687","article-title":"Comparison of 2-year complication rates among common techniques for postmastectomy breast reconstruction","volume":"153","author":"K G Bennett","year":"2018","journal-title":"JAMA Surg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2737-6539.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T22:46:10Z","timestamp":1792449970000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2737-6539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":30,"journal-issue":{"issue":"09","published-online":{"date-parts":[[2026,10,19]]},"published-print":{"date-parts":[[2026,11]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2737-6539","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11,6]]},"published":{"date-parts":[[2025,11,6]]}}}