Patterns and outcomes of breast reconstruction in older women – A systematic review of the literature

Oh, Daniel D.; Flitcroft, Kathy; Brennan, Meagan; Spillane, Andrew J.

doi:10.1016/j.ejso.2016.02.010

Cited by 53 publications

(76 citation statements)

References 63 publications

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“…BRCA1 and BRCA2 were the only genetic mutations identified in this population. A younger cohort of patients is less likely to be affected by co‐morbidities such as cardiovascular or respiratory disease, making them more suitable candidates for longer and possible additional procedures required to complete the breast reconstruction24. In the present cohort, patients aged under 60 years were more likely to undergo breast reconstruction than older patients, despite receipt of chemotherapy, which may be influenced by chemotherapy‐induced morbidity in older patients in addition to treatment fatigue.…”

Section: Discussionmentioning

confidence: 72%

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

et al. 2017

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BackgroundBreast reconstruction is an important component of multidisciplinary breast cancer management. The practice of breast reconstruction after mastectomy has evolved significantly in the past decade as a result of both increasing mastectomy rates and advances in reconstructive strategy. These changes have significantly influenced the contemporary surgical management of breast cancer. The aim of this study was to examine trends in breast reconstruction after mastectomy in an Irish population.MethodsData were reviewed from a database of all patients who had mastectomy with or without breast reconstruction at Galway University Hospital, a tertiary breast cancer referral centre, between 2004 and 2014. Trends in breast reconstruction after mastectomy were explored with respect to patient demographics, clinicopathological features, and neoadjuvant and adjuvant therapy.ResultsOf 1303 patients who underwent mastectomy during interval studied, 706 (54.2 per cent) had breast reconstruction after mastectomy. In 629 patients (89·1 per cent), breast reconstruction was performed in the immediate setting. Reconstruction rates increased over time from 20·5 per cent in 2004 to 44·7 per cent in 2014. Reconstruction was more commonly performed in younger patients and those with benign, in situ and early‐stage disease. A negative relationship between radiotherapy and reconstruction was observed. A pedicled flap with or without an implant was the most commonly used reconstructive approach in patients receiving radiotherapy.ConclusionBreast reconstruction after mastectomy has become the standard of care in the surgical treatment of breast cancer. Recent trends show a transition favouring implant‐based approaches.

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Section: Discussionmentioning

confidence: 72%

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

et al. 2017

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“…5 The audit covered immediate or delayed BR and included implant-based or autologous procedures. The clinical records of all women with primary operable breast cancer of any stage aged 60 or over at the time of diagnosis, and treated with mastectomy with or without BR, were reviewed.…”

Section: Methodsmentioning

confidence: 99%

“…7 The reluctance of some surgeons to offer BR to older women may be based on the patient's age alone, comorbidities, or an assumption that older women do not want or need BR. 5 An earlier study of patient-reported QoL outcomes for older women undergoing BR and no BR (NBR) showed no significant difference in QoL outcomes between the two groups, with both reporting good QoL and body image, and low levels of decisional regret. 8 A number of cross-sectional studies have demonstrated that age alone is not related to post-operative complications for BR and that older women benefit as much as younger women from receiving BR in terms of QoL.…”

Section: Introductionmentioning

confidence: 94%

“…This has led to an increased focus on maximizing the long-term quality of life (QoL) of patients. [5][6][7] For example, an audit of UK surgeons found 'a significant proportion' of older women were not offered immediate BR (IBR), regardless of their clinical suitability. 3,4 Despite this, the rate of BR remains low in patients aged 60 years and older.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Despite this, the rate of BR remains low in patients aged 60 years and older. 5 A 2016 systematic review revealed limited high quality studies on the outcomes of BR in older women and noted that older women were often underrepresented or excluded from published studies. 7 The reluctance of some surgeons to offer BR to older women may be based on the patient's age alone, comorbidities, or an assumption that older women do not want or need BR.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of breast reconstruction in older women: patterns of uptake and clinical outcomes in a large metropolitan practice

Flitcroft

Brennan

et al. 2019

ANZ Journal of Surgery

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Background: Older age is associated with lower rates of breast reconstruction (BR) following mastectomy. This study compared a range of factors in women aged 60 years and older who had received mastectomy and BR with those who received no BR (NBR). Methods: An audit of 338 women aged 60 or over treated with mastectomy with (n = 86) or without (n = 252) BR for primary breast cancer from 2009 to 2016 was conducted. Demographic, tumour, treatment, comorbidity and surgical complication data were obtained from patient medical records. Results: NBR patients were associated with older age (P ≤ 0.001), more comorbidities (P = 0.038) and more extensive disease (P = 0.001) than BR patients. Total number of complications was not significantly different between BR and NBR patients (P = 0.286), or the different types of BR (P = 0.697). BR patients had higher rates of unplanned returns to the operating theatre, particularly in the late post-operative period (P = 0.025). Implant-based reconstruction was associated with more unplanned operating theatre returns than autologous reconstruction in the late post-operative period (P = 0.013). Conclusion: Post-mastectomy BR in elderly patients has a clinical complication profile similar to NBR patients. This audit found no clinical-based reasons to not offer oncologically suitable and clinically fit elderly women the option of BR.

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

Kamali

Curiel

Veldhuisen

et al. 2017

Journal of Surgical Oncology

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Patterns and outcomes of breast reconstruction in older women – A systematic review of the literature

Cited by 53 publications

References 63 publications

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

Outcomes of breast reconstruction in older women: patterns of uptake and clinical outcomes in a large metropolitan practice

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

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