{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T01:41:47Z","timestamp":1773970907240,"version":"3.50.1"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"Abstract<\/jats:title>\n Abdominally based free flap breast reconstruction offers excellent long-term outcomes, but donor-site morbidity remains a concern. Lower back pain is a prevalent musculoskeletal condition that may impair core stability and abdominal donor-site recovery after surgery. This study evaluated the association between a preexisting diagnosis of lower back pain and long-term physical well-being of the abdomen after surgery.<\/jats:p>\n We conducted a retrospective study of patients who underwent abdominally based free flap breast reconstruction between 2017 and 2024. Patients were categorized by the presence or absence of a preexisting diagnosis of lower back pain. The primary outcome was physical well-being of the abdomen, assessed using the BREAST-Q. Multivariable linear mixed-effects models evaluated the association between lower back pain and abdominal well-being.<\/jats:p>\n A total of 2,594 patients were included. Donor-site complications occurred in 15% of patients, including wound dehiscence (9.1%), surgical site infection (4.3%), palpable bulge (2.4%), seroma (2.2%), and hematoma (0.5%). Patients with preexisting lower back pain (n\u2009=\u2009298, 11.5%) had significantly lower abdominal well-being scores compared with those without at 1 year (62 vs. 69; p\u2009<\u20090.001) and 5 years (65 vs. 76; p\u2009=\u20090.014). On multivariable analysis, lower back pain was independently associated with worse abdominal well-being (\u03b2\u2009=\u2009\u22125, 95% confidence interval [CI]: \u22128.9 to \u22120.97; p\u2009=\u20090.015), exceeding the minimal clinically important difference of \u22654.<\/jats:p>\n Preexisting lower back pain is associated with significantly worse long-term abdominal well-being after breast reconstruction. Future studies should investigate targeted interventions such as pre- and postoperative core rehabilitation protocols to improve outcomes in these high-risk patients.<\/jats:p>","DOI":"10.1055\/a-2824-6370","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:04:01Z","timestamp":1772496241000},"source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Lower Back Pain is a Risk Factor for Worse Physical Well-Being of the Abdomen After Breast Reconstruction"],"prefix":"10.1055","author":[{"given":"Ronnie L.","family":"Shammas","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillian A.","family":"Boe","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Wang","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis D.","family":"Graziano","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey E.","family":"Hespe","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"Allen Jr","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie S.","family":"Stern","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan","family":"Matros","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas A.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babak J.","family":"Mehrara","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/SLA.0000000000003467","article-title":"Long-term patient-reported outcomes following postmastectomy breast reconstruction: an 8-year examination of 3268 patients","volume":"270","author":"J A Nelson","year":"2019","journal-title":"Ann Surg"},{"issue":"02","key":"ref2","first-page":"121","article-title":"The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap","volume":"30","author":"C Healy","year":"2014","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"204e","DOI":"10.1097\/PRS.0000000000002855","article-title":"Evidence-based medicine: autologous breast reconstruction","volume":"139","author":"S A Macadam","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/SLA.0000000000002033","article-title":"Complications in postmastectomy breast reconstruction: one-year outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) study","volume":"267","author":"E G Wilkins","year":"2018","journal-title":"Ann Surg"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/PRS.0000000000004016","article-title":"Complications and patient-reported outcomes after abdominally based breast reconstruction: results of the Mastectomy Reconstruction Outcomes Consortium 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critical review","volume":"124","author":"L X Man","year":"2009","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1097\/01.prs.0000479932.11170.8f","article-title":"Quality of life and patient-reported outcomes in breast cancer survivors: a multicenter comparison of four abdominally based autologous reconstruction methods","volume":"137","author":"S A Macadam","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","article-title":"What low back pain is and why we need to pay attention","volume":"391","author":"J Hartvigsen","year":"2018","journal-title":"Lancet"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s11136-022-03213-z","article-title":"Moving towards patient-reported outcomes in routine clinical practice: implementation lessons from the 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Microsurg"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1055\/s-0044-1788564","article-title":"A DIEP dive into patient risk factors for hernia and bulge development: a meta-regression","volume":"41","author":"N Rezania","year":"2025","journal-title":"J Reconstr Microsurg"},{"issue":"10","key":"ref16","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1001\/jamasurg.2018.1677","article-title":"Long-term patient-reported outcomes in postmastectomy breast reconstruction","volume":"153","author":"K B Santosa","year":"2018","journal-title":"JAMA Surg"},{"issue":"09","key":"ref17","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S0003-9993(99)90052-7","article-title":"Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds","volume":"80","author":"P W Hodges","year":"1999","journal-title":"Arch Phys Med 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Berkvens","year":"2021","journal-title":"Int J Abdom Wall Hernia Surg"},{"issue":"02","key":"ref21","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.surg.2021.03.006","article-title":"Preoperative exercise and outcomes after ventral hernia repair: making the case for prehabilitation in ventral hernia patients","volume":"170","author":"S M Renshaw","year":"2021","journal-title":"Surgery"}],"container-title":["Journal of Reconstructive 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