Effect of Patient Age on Outcomes in Breast Reconstruction: Results from a Multicenter Prospective Study

Abstract

Background Although over 40% of new breast cancer diagnoses in the U.S. are in older women, few studies have assessed the outcomes of post-mastectomy reconstruction in this population. Our objective was to evaluate age effects on postoperative complications and patient-report outcomes (PROs) in women undergoing breast reconstruction, and to investigate whether age effects differ between reconstructive procedure types. Study Design Eligible patients in the Mastectomy Reconstruction Outcomes Consortium study from 11 institutions (57 providers) in North America were analyzed. Two-year complications and PROs via BREAST-Q domains were compared across younger (<45 years), middle-aged (45–60 years), and older (>60 years) women. Mixed-effects regression models were used, controlling for a range of demographic and clinical covariates. Results A total of 1,531 patients were studied: 494 younger, 803 middle-aged, and 234 older. Age was not a significant predictor of complications. For sexual well-being two years post-reconstruction, older women reported 4.25 (p=0.04) higher mean scores with implant procedures, and 10.39 (p<.01) higher mean scores with autologous procedures compared to younger women. No age effect was seen with implant procedures with regards to physical and psychosocial well-being; however, older women who underwent autologous procedures reported 6.07 (p<.01) higher physical and 8.21 (p<.01) higher psychosocial well-being scores than younger women. Conclusions Age did not significantly affect complication rates. Older women demonstrated higher sexual well-being for both procedures, and better satisfaction, physical and psychosocial well-being than younger women with autologous procedures. Post-mastectomy reconstruction is a viable option for older patients, with risks and benefits comparable to those in younger women.

Comparison of risk factors and complications in patients by stratified mastectomy weight: An institutional review of 1041 consecutive cases

“…11 However, there are also studies that report that increasing age in the setting of microvascular breast reconstruction did not lead to an increase in overall complications. 12,13,40 It is unclear why age was not a risk factor for overall complications in the larger two mastectomy weight cohorts. Regardless of mastectomy weight, there are demonstrated benefits for women undergoing reconstruction, most notably improved satisfaction with physical appearance and greater sexual well-being than younger women.…”

“…Butz et al found age to be a risk factor for VTE formation in the elderly undergoing autologous based reconstruction . However, there are also studies that report that increasing age in the setting of microvascular breast reconstruction did not lead to an increase in overall complications . It is unclear why age was not a risk factor for overall complications in the larger two mastectomy weight cohorts.…”

“…It is unclear why age was not a risk factor for overall complications in the larger two mastectomy weight cohorts. Regardless of mastectomy weight, there are demonstrated benefits for women undergoing reconstruction, most notably improved satisfaction with physical appearance and greater sexual well‐being than younger women . All of these women require appropriate preoperative counselling and management of peri‐operative risk factors.…”

“…Complication rates of women undergoing mastectomy have been welldescribed in the literature [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] ; however, with the ever increasing rate of women undergoing mastectomy it is important to ensure that the complication profile is regularly evaluated. We found that increase in mastectomy weight led to a significant increase in overall complications, seroma, surgical site infection, and hospital readmission.…”

Trends in immediate breast reconstruction and early complication rates among older women: A big data analysis

“…In line with our results, Fisher et al, reported that advanced age not to be a predictor for complication rates after immediate breast reconstruction. More recently, Santosa et al prospectively analyzed complication rates in patients undergoing immediate vs delayed breast reconstruction with follow‐up period of 2 years. They grouped the patients into three groups: <45 years, 45‐60 years and >60 years of age, and found that increased age does not effect breast reconstruction complication.…”