Age-dependent Characteristics in Women with Breast Cancer: Mastectomy and Reconstructive Trends at an Urban Academic Institution

Abstract

Breast reconstruction is an important aspect of treatment after breast cancer. Postmastectomy reconstruction bears a significant impact on a woman's postsurgical confidence, sexuality, and overall well-being. Previous studies have inferred that women under age 40 years have unique characteristics that distinguish them from an older cohort. Identifying age-dependent trends will assist with counseling women on mastectomy and reconstruction. To identify age-dependent trends, 100 consecutive women were sampled from a prospectively maintained breast reconstruction database at an urban academic institution from June 2010 through June 2013. Women were placed into two cohorts <40 and ≥40 as well cohorts by decade (20s, 30s, 40s, 50s, and 60s). Statistical trends were reported as odds of risk per year of increasing age using logistic regression; linear regression, χ2, and Fischer's exact were used to compare <40 and ≥40 and split cohorts for comparison. Comorbidities, tumor staging, oncologic treatment including chemotherapy and radiation, disease characteristics and genetics, and mastectomy, reconstructive and symmetry procedures were evaluated. Statistical analysis was performed using SAS software. In 100 patients of the sample study cohort, 151 reconstructions were performed. Increasing age was associated with one or more comorbidities [odds ratio (OR) = 1.07, P = 0.005], whereas younger age was associated with metastatic disease (OR = 0.88, P = 0.006), chemotherapy (OR = 0.94, P = 0.01), and radiation (OR = 0.94, P = 0.006); split cohorts demonstrated similar trends ( P < 0.005). Mastectomy and reconstructive characteristics associated with younger age included bilateral mastectomy (OR = 0.94, P = 0.004), tissue expander (versus autologous flap) (OR = 0.94, P = 0.009), extra high implant type (OR = 0.94, P = 0.049), whereas increasing use of autologous flaps and contralateral mastopexy symmetry procedures (OR = 1.09, P = 0.02) were associated with an aging cohort. Increasing age was not associated with an increasing likelihood of complications ( P = 0.75). Age-related factors play a role in the treatment of patients with breast cancer. Younger women typically present with more aggressive features requiring oncologic treatment including chemotherapy and radiation. Mastectomy and reconstructive choices also demonstrate age-dependent characteristics. Women in younger age groups are more likely to pursue risk-reduction procedures and implant-based strategies, whereas older women had a higher propensity for abdominal-based autologous reconstruction. In addition, preferential reconstructive strategies correlate with age-dependent archetypical features of the breast (higher profile implants in younger patients; autologous reconstruction on affected side mimicking natural ptosis, and contralateral mastopexy in older patients). These trends seem to be consistent with each increasing year of age. Age-related preferences and expectations, age-dependent body habitus and breast shape, and lifetime risk play a role in the choices pursued for mastectomy and reconstruction.

Sexuality, depression and body image after breast reconstruction

“…Breast reconstruction is an oncologically safe procedure that improves the patient's self-esteem without increasing the risk of relapse or delaying the diagnosis of local recurrence (7). The reconstruction of the breast after mastectomy may preserve a woman's self-concept and improve her body image (23) and quality of life, resulting in a less traumatic rehabilitation process compared to that for mastectomy alone (24), especially among younger women, who give greater importance to body image than older women (25).…”

Comparison of overall survival after neoadjuvant and adjuvant chemotherapy in patients with early breast cancer with immediate breast reconstruction after mastectomy: A retrospective, matched case‑control study

“…The current results reveal that 77.7% of the unmatched and 81.8% of the matched patients were <50 years old, indicating that the preference for immediate breast reconstruction after mastectomy decreases with age. Studies have demonstrated that compared with older patients, younger patients with breast cancer are physiologically healthier, which makes them better candidates for breast reconstruction ( 7 , 31 ). Breast cancer in younger patients is likely to be more aggressive, leading to poorer quality of life and more mental health issues; however, the younger breast cancer cohort is also preferred for reconstructive options ( 7 , 31 , 32 ).…”

“…Studies have demonstrated that compared with older patients, younger patients with breast cancer are physiologically healthier, which makes them better candidates for breast reconstruction ( 7 , 31 ). Breast cancer in younger patients is likely to be more aggressive, leading to poorer quality of life and more mental health issues; however, the younger breast cancer cohort is also preferred for reconstructive options ( 7 , 31 , 32 ). Moreover, the recent increase in the awareness and knowledge of, the increase in communication with professionals on and the development of decision support tools related to breast reconstruction may have also led to the increase in the preference for breast reconstruction among the younger breast cancer cohort ( 33 , 34 ).…”

“…Growing global interest in breast reconstruction research and the growth of related studies have indicated that breast reconstruction is becoming an increasingly common options for both surgeons and patients, particularly for younger patients with breast cancer ( 6 , 7 ). Postmastectomy breast reconstruction may be performed immediately after the mastectomy or after systemic treatment, local treatment (radiotherapy) or both.…”

Risk‐reducing mastectomy decisions among women with mutations in high‐ and moderate‐ penetrance breast cancer susceptibility genes

“…Age has been contended as a decisional influencer for RRM for women with breast cancer (Bhat, 2017; Chagpar, 2006; Elsayegh, 2018; Hoskins, 2012; Rodby, 2016). Literature also suggests that age factors into decision making for unaffected women.…”