Assessment of Advanced Age as a Risk Factor in Microvascular Breast Reconstruction

Abstract

Advanced age should not be considered a risk factor for microvascular breast reconstruction. Because ASA status did predict overall surgical complications, surgeons should consider the patients' overall health status in deciding whether to operate.

Autologous Breast Reconstruction in Women Older Than 65 Years Versus Women Younger Than 65 Years

“…It is worth noting that in the present study, the rates of diabetes, smoking, and mean BMI are lower in our patients for both age groups than would be expected in the general population, and this is also true of other studies, 20,30 suggesting that there was a careful preoperative screening process that contributed to the overall success.…”

“…35 Although there are many well-recognized physiological changes associated with advanced age, such as declines in cardiac, pulmonary, and renal function, recent studies have shown that age alone is not an independent predictor of poor postoperative outcome after major surgery, including head and neck, breast reconstruction, and microvascular flap reconstruction. 14,26,28,[30][31][32]38,39 Literature in this area is scarce; however, it does suggest that medical complications as opposed to surgical complications are often a cause of perioperative morbidity, and they are often a result of preexisting conditions as opposed to advanced age. 28,38 A more accurate predictor of morbidity and mortality is the American Society of Anesthesiologist physical status.…”

“…Perhaps, this finding is partly due to the surgeon or referring physician's judgment of operative risks and partly due to the patient's own misconceptions about the excessive complications associated with such a procedure. 22,30 In 2006, a study based in Vancouver by Bowman et al 22 on breast reconstruction outcomes in elderly patients found that only 16% of patients who had delayed reconstruction was made aware of the option at first diagnosis and over 90% of these patients (who are older than 65 years) felt that age should not be a determining factor for breast reconstruction.…”

“…Recent findings show that age is not an independent risk factor for operative complications 3,[26][27][28][29] and that advanced age alone is not a predictor for poor outcomes after microvascular autologous breast reconstruction 30 and microvascular flap reconstruction. [31][32][33][34] There is scarce data examining breast reconstruction outcomes in the elderly; however, findings do suggest that attitudes and views on one's breasts and their symbolic importance do not change with age.…”

Microvascular tissue transfers in the elderly: safety analysis for a challenging area

“…The ASA scoring system was the dominant system used in the literature (2)(3)(4)(5)(6)(8)(9)(10)(12)(13)(14)(17)(18)(19)(20). Three studies calculated CCI scores (3,21,22) and only one study used the KFI (11).…”