The quality‐of‐life benefits of breast reconstruction do not diminish with age

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

doi:10.1002/jso.23864

Cited by 56 publications

(52 citation statements)

References 32 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.…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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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“…In one of the earliest studies using the BREAST-Q to examine the differences in PROs between women undergoing mastectomy alone versus reconstruction, Eltahir et al demonstrated lower BREAST-Q scores for Satisfaction with Breasts, Psychosocial Well-being, and Sexual Well-being in women after mastectomy alone versus mastectomy with reconstruction (23). These findings have been replicated in multiple subsequent studies (19, 20, 24, 25), including a prospective study by Chao et al that demonstrated lower Satisfaction with Breasts, Psychosocial Well-being, Sexual Well-being, and Physical Well-being Chest in patients undergoing mastectomy alone versus mastectomy with reconstruction (26). While BREAST-Q outcomes following BCT are not as well established, Satisfaction with Breasts scores after BCT with various incision techniques have been reported, along with findings of higher scores associated with lower quantities of resected tissue and scores associated with BCT lower than reconstruction yet higher than mastectomy alone (20, 27-29).…”

Section: Discussionmentioning

confidence: 73%

Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q

Mundy

Homa

Klassen

et al. 2017

Plastic &Amp; Reconstructive Surgery

141

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Background The BREAST-Q is a patient-reported outcome instrument used to evaluate outcomes in patients undergoing breast cancer surgery and reconstruction. Normative values for the BREAST-Q breast cancer modules have not been established, limiting data interpretation. Methods Participants were recruited via the Army of Women, an online community of women (with and without breast cancer), to complete mastectomy, breast conserving therapy (BCT), and reconstruction pre-operative BREAST-Q scales. Inclusion criteria were women aged ≥18 years without a prior history of breast surgery or breast cancer. Analysis included descriptive statistics, a linear multivariate regression, and a comparison of the generated normative data to previously published BREAST-Q findings. Results The BREAST-Q was completed by 1,201 women. Mean age was 54 ±13 years, mean body mass index (BMI) 26 ±6, and 38% (n=455) had a bra cup ≥D. Mean scores for BREAST-Q scales (±standard deviation) were as follows: Satisfaction with Breasts (58 ±18), Psychosocial Well-being (71 ±18), Sexual Well-being (56 ±18), Physical Well-being-Chest (93 ±11), and Physical Well-being-Abdomen (78 ±20). Women with BMI ≥30, cup size ≥D, age <40, and income <$40,000/year reported lower scores. Comparing normative scores to published data in breast cancer patients, Satisfaction with Breasts were higher after autologous reconstruction and lower after mastectomy, Sexual Well-being scores were lower after mastectomy and BCT, and Physical Well-being Chest scores were lower after mastectomy, BCT and reconstruction. Conclusions These are the first published normative scores for the BREAST-Q breast cancer modules, and provide a clinical reference point for the interpretation of data.

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“…Two studies suggested that older patients reported higher levels of overall quality of life after breast reconstruction . The remaining studies did not report significant differences between younger and older patients …”

Section: Resultsmentioning

confidence: 97%

A systematic review of factors affecting quality of life after postmastectomy breast reconstruction in women with breast cancer

et al. 2019

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Objective The aim of this study is to present a broader perspective of factors affecting the quality of life after postmastectomy breast reconstruction in women with breast cancer by considering these patients' self‐reported outcomes. Methods The search was performed from 29 March to 19 April 2019, on the following databases: PsycInfo; Web of Science Core Collection, Current Contents Connect, Derwent Innovations Index, KCI‐Korean Journal Database, Russian Science Citation Index, SciELO Citation Index, and MEDLINE. The studies were included if they identified factors affecting self‐reported quality of life after breast reconstruction, in women with breast cancer. Results One hundred and twenty‐two records were identified. After quality assessment, 44 studies were included for qualitative synthesis. This review comprised a total of 16 683 women who underwent breast reconstruction. The results identified a broad collection of 32 empirically based variables associated with several domains of quality of life. These variables were grouped into four categories: (a) surgical, (b) clinical, (c) psychosocial, and (d) sociodemographic variables. Conclusions This systematic review goes beyond surgical factors of morbidity and uses patient‐reported outcomes to scope wider issues that influence quality of life, such as psychosocial and sociodemographic variables. It sustains the need to adopt a more holistic approach and advises the consideration of preoperative psychosocial factors to better understand these patients' quality of life after breast reconstruction and to implement future preventive measures.

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The quality‐of‐life benefits of breast reconstruction do not diminish with age

Abstract: Older women who undergo PMBR have better breast-related QOL outcomes than those who do not. Moreover, the outcomes of PMBR in older women are similar to those seen in younger women. When appropriate, older women should be encouraged to consider PMBR.

Cited by 56 publications

References 32 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

Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q

A systematic review of factors affecting quality of life after postmastectomy breast reconstruction in women with breast cancer

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