Living in food deserts linked to complications after breast reconstruction surgery

For patients undergoing breast reconstruction, residing in a food desert may be associated with an increased risk of certain complications after surgery, reports a study in the April issue of Plastic and Reconstructive Surgery^®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

Our findings suggest that access to healthy foods and nutritional status may influence the risk of complications after breast reconstruction surgery. Food insecurity might be an important social determinant of health for breast reconstruction patients."

Kenneth Fan, MD, of Medstar Georgetown University Hospital, Washington, DC

Are complication risks higher for patients living in food deserts?

Food deserts are areas with high rates of food insecurity, with limited access to healthy foods and a high concentration of unhealthy food options. Previous studies have identified poor nutrition – a common issue in patients with food insecurity – as a critical factor affecting recovery after breast reconstruction.

The researchers analyzed data on 1,553 patients who underwent mastectomy between 2014 and 2018. In 1,020 patients – about two-thirds of the total – mastectomy was followed by breast reconstruction. Overall, 43.5% of patients lived in areas of low food access (LFA), based on distance to the nearest supermarket.

Patients living in LFA areas were more likely to be Black compared to those in non-LFA areas, 42% versus 37%; and had higher rates of diabetes and chronic kidney disease. Other patient characteristics were similar between groups. Overall, patients residing in food deserts were more likely to experience some type of complication: 54.5%, compared to 38.5% of those living in non-LFA areas. Patients who lived in food deserts were also at higher risk of major complications: 12.3% versus 7.3%.

'Critical role of nutrition' in recovery after breast reconstruction

On sub-analysis of the LFA group, patients living in low-income areas were at higher risk of complications requiring repeat surgery. After adjustment for other factors – including age, race, other medical conditions, income level, and type and timing of breast reconstruction – living in a food desert remained an independent risk factor for overall complications and repeat surgery.

Although previous studies have shown that socioeconomic factors such as income and insurance status affect breast reconstruction outcomes, Dr. Fan and colleagues write "Food desert status captures a separate issue…that is not fully accounted for by income alone." The researchers note some limitations of their study, which cannot show any causal relationship between food deserts and postoperative complications.

"These findings emphasize the critical role of nutrition in recovery and suggest that geographic and socioeconomic disparities contribute to health outcomes," Dr. Fan and coauthors conclude. Pending further studies, they suggest that adding nutritional screening to preoperative patient assessments might help to mitigate the adverse effects of poor nutrition on complication risks after breast reconstruction.