Age and Breast Reconstruction

Chang-Azancot, Luis; Gijón, María; Kenig, Nitzan; Campello, Manuel; Juez, Jessica; Talaya, Antonio; Gómez-Bajo, Gregorio; Montón, Javier; Sánchez-Bayona, Rodrigo

doi:10.1007/s00266-022-03024-0

Cited by 6 publications

(5 citation statements)

References 52 publications

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“…The data of the present study showed that rates of complications in patients submitted to IBR did not statistically differ between patients aged ≤60 years and those >60 years ( p = 0.34). These findings are consistent with reports underscoring that age at breast reconstruction is not associated with a higher risk of surgical complications 24 . For example, in a study investigating the use of DIEP flaps in 79 patients aged 65 years or older, success and complication rates, as well as satisfaction scores, were similar than younger patients 7 .…”

Section: Discussionsupporting

confidence: 90%

“…These findings are consistent with reports underscoring that age at breast reconstruction is not associated with a higher risk of surgical complications. 24 For example, in a study investigating the use of DIEP flaps in 79 patients aged 65 years or older, success and complication rates, as well as satisfaction scores, were similar than younger patients. 7 Similarly, in another retrospective study including 309 patients aged 60 years or older undergoing breast reconstruction, there was no difference in complication rates.…”

Section: Temporal Trendsmentioning

confidence: 96%

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Rising age‐specific rates of immediate breast reconstruction after mastectomy: Report from an Italian Breast Unit

Fancellu,

Deiana,

Sanna

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesImmediate breast reconstruction (IBR) represents a fundamental part in the management of patients receiving mastectomy. In recent years, there has been an increasing trend in the use of IBR in all age groups. The study aims were to evaluate the age‐specific trend of IBR, and to discuss its effects in work organization at an Italian Breast Unit.MethodsWe searched for women diagnosed with breast cancer between 2010 and 2019, focusing on IBR rates in patients who received mastectomy. Age‐specific trends were assessed using the Cochrane–Armitage test. Differences in operative times and hospital stay between women undergoing mastectomy + IBR (Ma + IBR) or mastectomy alone (Ma) were evaluated by Student's t test or χ2 test.ResultsAmong 1915 patients, 62.4% underwent breast conserving surgery (BCS), and 37.6% mastectomy. Overall, rates of Ma + IBR increased from 32% in 2010 to 58% in 2019 (p < 0.001). Although rates of IBR rose in all age groups, the trend was significantly increased among patients aged 50–59 (p < 0.001), 60–69 (p < 0.0001), and 70–79 (p < 0.05).ConclusionsRates of Ma + IBR have increased over years, especially among older women. Ma + IBR resulted in longer operative times and hospital stay than Ma alone. These findings imply that, in the near future, resources should be implemented to improve and strengthen the surgical activity of Breast Units, to support the increasing use of IBR in women of all age groups.

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Section: Discussionsupporting

confidence: 90%

Section: Temporal Trendsmentioning

confidence: 96%

Rising age‐specific rates of immediate breast reconstruction after mastectomy: Report from an Italian Breast Unit

Fancellu,

Deiana,

Sanna

et al. 2023

Journal of Surgical Oncology

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“…15 Most recently, Chang-Azancot et al studied 304 patients who underwent both implant-based and ABR but saw no significant difference in overall complications between their two cohorts of patients younger and older than 65. 16 The overwhelming consensus from these studies is that there is no significant difference in outcomes between younger and older patients, yet many surgeons continue to avoid free flap breast reconstruction in the elderly. 24 However, each of these examples from the literature shares a commonality in that their analyses were performed by categorizing age into groups, such as treating the treatment cohort as patients aged >65.…”

Section: Discussionmentioning

confidence: 99%

“…7,10 Age has previously been evaluated as an independent risk factor for surgical outcomes following autologous reconstruction and has been largely determined to be an irrelevant determinant. [11][12][13][14][15][16] Yet, many surgeons remain hesitant to perform autologous reconstruction in elderly women and may not be universally offered to patients of advanced age due to perceived excessive perioperative risk. 17 Further contributing to this debate, age cutoffs of 65 years have arbitrarily been used to delineate the analyses of cohorts in previous studies.…”

mentioning

confidence: 99%

Increased Patient Age as a Risk Factor Following Free Flap Reconstruction after Breast Cancer: A Single Institutional Review of 2,598 Cases

Honig,

Habarth-Morales,

Davis

et al. 2024

J Reconstr Microsurg

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Background Autologous breast reconstruction (ABR) after mastectomy is increasing due to benefits over implant-based reconstruction. However, free flap reconstruction is not universally offered to patients of advanced age due to perceived increased perioperative risk. Methods Patients undergoing free flap breast reconstruction at our institution from 2005 to 2018 were included. Risk-adjusted logistic regression models were fit while controlling for demographic and comorbid characteristics to determine the association of age with the probability of venous thromboembolism (VTE), delayed healing, skin necrosis, surgical site infection (SSI), seroma, hematoma, hernia, and flap loss. Linear predictions from risk-adjusted logistic regression models were used to create spline curves and determine the risk of outcomes associated with age. Results A cohort of 2,598 patients underwent free flap breast reconstruction in the period examined. The median age was 51 with approximately 9% of patients being 65 or older. Increased age was associated with a greater risk of delayed healing, skin necrosis, and hematoma after surgery. There was no increased risk of medical complications such as VTE or complications such as flap loss, seroma, or SSI. Conclusion A set age cutoff for patients undergoing free flap breast reconstruction does not appear warranted. There is no difference in major surgical complications such as flap loss with increasing age. However, older age does predispose patients to specific wound complications such as hematoma, skin necrosis, and delayed wound healing, which should guide preoperative counseling. Further, medical complications do not increase with advanced age. Overall, however, the safety of ABR in older patients appears uncompromised.

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“…A retrospective analysis in a single center recently showed that age should not be a limiting factor when considering BR following mastectomy, as it was not associated with an increased risk of surgical complications. Notably, RT and smoking history were significant predictors of surgical complications ( 18 ).…”

Section: Basic Concepts In Breast Reconstructionmentioning

confidence: 99%

Technical consideration for breast reconstruction in patients requiring neoadjuvant or adjuvant radiotherapy: a narrative review

Maita,

Torres-Guzman,

Avila

et al. 2023

Ann Transl Med

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Background and Objective Surgical considerations for breast reconstruction (BR) in patients requiring neoadjuvant radiotherapy (NART) or adjuvant radiotherapy (ART) cannot be understated. The management of irradiated tissue leads surgeons to face several challenges. Therefore, it is essential to comprehensively understand the proper patient selection and preoperative planning to ensure the best outcomes and minimize the risk of complications. This narrative review aims to provide an update and summary of the most important technical considerations every breast surgeon must contemplate reconstructing the irradiated breast. Methods The search strategy was performed on January 10th, 2023. The PubMed, Embase, Cochrane Library, and Web of Science databases were queried to capture all publications regarding surgical considerations in BR of patients undergoing NART and ART. Key Content and Findings This review shows that the effects of radiotherapy (RT) on BR are still being studied. RT represents an essential factor for overall patient survival, and its use is increasing. However, the range of RT treatments across different cancer centers complicates the creation of a single treatment protocol. BR improves women’s quality of life, so finding the proper integration of BR and RT is essential. When deciding on the reconstructive method, there are several factors to consider, such as the patient’s body characteristics, tumor stage, RT protocol, and chemotherapy. To achieve the best surgical results and the most satisfied patient, using less aggressive and safer RT methods in the treatment sequence is recommended. Conclusions The timing of the radiation will influence the selection of the best reconstructive methods to be employed in the breast cancer patient. However, there is clear evidence of preference for immediate autologous-based BR in cases due to the low rate of complications in the long term. But patient individualization is the key. Therefore, the benefits and risks of immediate versus delayed and autologous versus implant-based reconstruction must be weighed in every single case.

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Age and Breast Reconstruction

Cited by 6 publications

References 52 publications

Rising age‐specific rates of immediate breast reconstruction after mastectomy: Report from an Italian Breast Unit

Rising age‐specific rates of immediate breast reconstruction after mastectomy: Report from an Italian Breast Unit

Increased Patient Age as a Risk Factor Following Free Flap Reconstruction after Breast Cancer: A Single Institutional Review of 2,598 Cases

Technical consideration for breast reconstruction in patients requiring neoadjuvant or adjuvant radiotherapy: a narrative review

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