Preoperative Lower Back Pain Is a Risk Factor for Worse Physical Well-Being of the Abdomen After Breast Reconstruction

Published on March 3, 2026

J Reconstr Microsurg. 2026 Mar 2. doi: 10.1055/a-2824-6370. Online ahead of print.

ABSTRACT

INTRODUCTION 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. METHODS We conducted a retrospective study of patients who underwent abdominally based free flap breast reconstruction between 2017-2024. 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 BREAST-Q. Multivariable linear mixed-effects models evaluated the association between lower back pain and abdominal well-being. RESULTS 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=298, 11.5%) had significantly lower abdominal well-being scores compared to those without at 1 year (62 vs. 69; p<0.001) and 5 years (65 vs. 76; p=0.014). On multivariable analysis, lower back pain was independently associated with worse abdominal well-being (β = -5, 95% CI: -8.9 to -0.97; p=0.015), exceeding the minimal clinically important difference of ≥4.

CONCLUSION 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.

PMID:41771493 | DOI:10.1055/a-2824-6370

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