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

Song, Diana; Slater, Karen; Laeken, Nancy Van; Zhong, Toni; Hazen, Alexes; Vidal, Dale C.; Macadam, Sheina A.

doi:10.1097/sap.0000000000000527

Cited by 35 publications

(49 citation statements)

References 38 publications

(54 reference statements)

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“…Our results confirm previous findings that advancing age is not a predictor of complications following breast reconstruction (15, 17, 30). However, we did observe significant age-related differences in some of the PRO measures; while older women reported greater sexual well-being than younger women, patients over 60 years were less satisfied with their reconstruction than their younger counterparts.…”

Section: Discussionsupporting

confidence: 92%

“…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%

“…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). However, these studies did not include any complication data.…”

Section: Discussionmentioning

confidence: 99%

“…While other studies have sought to determine the effects of advancing age on breast reconstruction outcomes, they have been largely retrospective in design (14–17) or focused on one type of reconstruction, either implant-based or autologous techniques (15, 18). For our current study, we sought to evaluate the effects of age on postoperative complications and patient-reported outcomes (PROs) in a large multicenter, prospective study of women who underwent breast reconstruction in the United States and Canada.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Previous studies of age effects on breast reconstruction complications have produced mixed results. A multicenter, retrospective analysis by Song et al 17 assessing outcomes of autologous reconstructions in 1809 patients concluded that complications in elderly patients were “equivalent,” compared with those of younger women. In an analysis of free flap breast reconstructions, Selber et al 18 reported no difference in complications between patients under 65 and those 65 years or older.…”

Section: Discussionmentioning

confidence: 99%

Complications in Postmastectomy Breast Reconstruction

et al. 2018

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Objective In postmastectomy reconstruction, procedure choice is heavily influenced by the relative risks of the various options. This study sought to evaluate complications in a large, multicenter patient population. Summary of Background Data Previous studies have reported widely varying complication rates, but have been limited by their single center designs and inadequate controlling for confounders in their analyses. Methods Eleven sites enrolled women undergoing first time, immediate, or delayed reconstruction following mastectomy for cancer treatment or prophylaxis. Procedures included expander/implant, latissimus dorsi (LD), pedicle transverse rectus abdominis musculocutaneous (PTRAM), free TRAM (FTRAM), and deep inferior epigastric perforator (DIEP) techniques. Data were gathered pre- and postoperatively from medical records. Separate logistic regressions were conducted for all complications and major complications (those requiring rehospitalization and/or reoperation) within 1 year. Odds ratios (ORs) were calculated for procedure type, controlling for site, demographic, and clinical variables. Results Complication rates for 2234 patients were analyzed. Compared with expander/implant reconstructions, LD (OR) 1.95, P = 0.026), PTRAM (OR 1.89, P = 0.025), FTRAM (OR 1.94, P = 0.011), and DIEP (OR 2.22, P < 0.001) procedures were associated with higher risks of complications. Significantly higher risks were also associated with older age, higher body mass index (BMI), immediate reconstruction, bilateral procedures, and radiation. For major complications, regression showed significantly greater risks for PTRAM (OR 1.86, P = 0.044) and DIEP (OR 1.75, P = 0.004), than expander/implant reconstructions. Failure rates were relatively low, ranging from 0% for PTRAM to 5.9% for expander/implant reconstructions. Conclusion In this multicenter analysis, procedure choice and other patient variables were significant predictors of 1-year complications in breast reconstruction. These findings should be considered in counseling patients on reconstructive options.

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

Cited by 35 publications

References 38 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

Complications in Postmastectomy Breast Reconstruction

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

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