Advanced Age Does Not Worsen Recovery or Long-Term Morbidity After Postmastectomy Breast Reconstruction

Johnson, Daniel N.; Lapin, Brittany; Wang, Chi‐Hsiung; Yao, Katharine; Rasinski, Kenneth A.; Rundell, Veronica; Sisco, Mark

doi:10.1097/sap.0000000000000512

Cited by 16 publications

(36 citation statements)

References 51 publications

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“…Results from studies evaluating PROs in older women undergoing breast reconstruction are more consistent in their findings, demonstrating that older women achieve similar or even higher levels of satisfaction than younger women post-reconstruction (14, 15, 28, 29). For example, Sisco and coworkers (29) conducted a prospective cohort study of 315 patients undergoing immediate reconstruction and found that patients over 65 years of age achieved similar quality of life scores to younger patients.…”

Section: Discussionmentioning

confidence: 60%

“…For example, Sisco and coworkers (29) conducted a prospective cohort study of 315 patients undergoing immediate reconstruction and found that patients over 65 years of age achieved similar quality of life scores to younger patients. Similarly, Johnson and colleagues (28) found that women 65 years or older reported similar physical and upper body well-being scores, compared with younger women. Moreover, in a study of 1,751 patients who underwent autologous reconstruction, patients over 65 years and younger women achieved similar high levels of satisfaction (15).…”

Section: Discussionmentioning

confidence: 78%

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

Santosa

Kim

et al. 2016

Journal of the American College of Surgeons

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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.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 78%

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

Santosa

Kim

et al. 2016

Journal of the American College of Surgeons

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“…Elderly postmastectomy breast reconstruction patients are underrepresented, and even more so in the subgroup of IBC patients. This is evident in our small sample size, and this is likely due to the fact that IBR is presently considered contraindicated for IBC patients.…”

Section: Discussionmentioning

confidence: 99%

Immediate breast reconstruction for women having inflammatory breast cancer in the United States

Patel

Nardello

et al. 2018

Cancer Medicine

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Inflammatory breast cancer (IBC) is an aggressive malignancy having a poor prognosis. Traditionally, reconstruction is not offered due to concerns about treatment delay, margin positivity, recurrence, and poor long‐term survival. There is a paucity of literature, however, evaluating whether immediate breast reconstruction (IBR) is associated with greater mortality in patients with IBC. A population‐based study was conducted via the SEER‐Medicare‐linked database (1991‐2009). Female patients greater than 65 years were reviewed who had mastectomy and reconstruction claims for nonmetastatic IBC. Competing risk and Cox regression were used to assess whether IBR was associated with higher breast cancer‐specific mortality (BCSM) or overall mortality (OM). Among 552 936 patients, 1472 (median age 74 years) were diagnosed with IBC and had a mastectomy. Forty‐four patients (3%) underwent IBR. Younger age, a lower Charlson comorbidity score, and a greater median income were predictors of IBR use. Tumor grade, hormone receptor status, and lymph node status were independent predictors of adjusted OM and BCSM. There was no difference by IBR status in BCSM or covariate‐adjusted BCSM (sHR 1.04; CI 0.71‐1.54; P = .83 and sHR 1.13; CI 0.84‐1.93; P = .58, respectively). Cumulative incidence of OM was lower among IR patients (P = .013), and IR did not influence the cumulative incidence of BCSM (P = .91). IBR was not associated with increased overall and BCSM mortality. Although further study of IBR in the IBC setting may be of value, these data suggest that IBC should not be considered an absolute contraindication to IBR.

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“…Age was shown to be an independent risk factor for overall complications in those with a mastectomy weight <500 g; however, it was not a significant predictor for overall complications in the two larger breast size cohorts. Age has previously been extensively analyzed and is recognized as a being a strong risk factor for post‐operative complications . Butz et al found age to be a risk factor for VTE formation in the elderly undergoing autologous based reconstruction .…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Chattha

Bucknor

Kamali

et al. 2017

Journal of Surgical Oncology

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Advanced Age Does Not Worsen Recovery or Long-Term Morbidity After Postmastectomy Breast Reconstruction

Cited by 16 publications

References 51 publications

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

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

Immediate breast reconstruction for women having inflammatory breast cancer in the United States

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

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