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Age and Breast Reconstruction

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  • Breast Surgery
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Abstract

Background

Breast reconstruction is frequently offered to cancer patients who undergo mastectomy. Older women tend to have lower rates of reconstruction mostly due to an age-based discretion. We aimed to assess the safety of this surgery in this population.

Methods

We conducted a single-center retrospective analysis of patients who underwent breast reconstruction following mastectomy between 2015 and 2020 at “Complejo Hospitalario Universitario de Albacete.” Patients were classified according to age when the reconstruction process began (group A: < 65 years–group B: > 65 years). Differences in demographics and clinical data were analyzed using Student’s t test and Chi-square test. Multivariable logistic regression models were used to estimate odds ratio (OR) and confidence intervals (CIs) for surgical complications according to age group. Propensity-score matching was used as a sensitivity analysis to test consistency among results.

Results

We included 304 women (266: group A–38: group B). Complete reconstruction was achieved in 48.1% of patients in group A vs 10.5% in group B (P < 0.001). After adjusting for potential confounders, age was not associated with an increased risk of surgical complications, neither overall (OR 0.88, 95%CI 0.40–1.95), early (OR 1.35, 95%CI 0.58–3.13) nor late (OR 1.05, 95%CI 0.40–2.81). Radiotherapy and smoking history were significant predictors for complications in every setting.

Conclusions

In our cohort, age at breast reconstruction is not associated with a higher risk of surgical complications, in contrast to radiotherapy and smoking history. Therefore, age should not be a limiting factor when considering breast reconstruction.

Level of Evidence IV

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References

  1. Galceran J, Ameijide A, Carulla M, Mateos A, Quirós JR, Rojas D et al (2017) Cancer incidence in Spain, 2015. Clin Transl Oncol 19(7):799–825

    Article  CAS  PubMed  Google Scholar 

  2. Girotto JA, Schreiber J, Nahabedian MY (2003) Breast reconstruction in the elderly: preserving excellent quality of life. Ann Plast Surg 50(6):572–578

    Article  PubMed  Google Scholar 

  3. Oh DD, Flitcroft K, Brennan ME, Spillane AJ (2016) Patterns and outcomes of breast reconstruction in older women – a systematic review of the literature. Eur J Surg Oncol EJSO 42(5):604–615

    Article  CAS  PubMed  Google Scholar 

  4. Oh DD, Flitcroft K, Brennan ME, Snook KL, Spillane AJ (2019) Outcomes of breast reconstruction in older women: patterns of uptake and clinical outcomes in a large metropolitan practice. ANZ J Surg 89(6):706–711

    Article  PubMed  Google Scholar 

  5. Quemener J, Wallet J, Boulanger L, Hannebicque K, Chauvet M, Régis C (2019) Decision-making determinants for breast reconstruction in women over 65 years old. Breast J 25(6):1235–1240

    Article  PubMed  Google Scholar 

  6. Sisco M, Johnson DB, Wang C, Rasinski K, Rundell VL, Yao KA (2015) The quality-of-life benefits of breast reconstruction do not diminish with age: breast reconstruction in older women. J Surg Oncol 111(6):663–668

    Article  PubMed  Google Scholar 

  7. Chang EI, Vaca L, DaLio AL, Festekjian JH, Crisera CA (2011) Assessment of advanced age as a risk factor in microvascular breast reconstruction. Ann Plast Surg 67(3):255–259

    Article  CAS  PubMed  Google Scholar 

  8. Pusic A, Thompson TA, Kerrigan CL, Sargeant R, Slezak S, Chang BW et al (1999) Surgical options for the early-stage breast cancer: factors associated with patient choice and postoperative quality of life. Plast Reconstr Surg 104(5):1325–1333

    Article  CAS  PubMed  Google Scholar 

  9. Brennan ME, Spillane AJ (2013) Uptake and predictors of post-mastectomy reconstruction in women with breast malignancy–systematic review. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 39(6):527–541

    CAS  Google Scholar 

  10. Lipa JE, Youssef AA, Kuerer HM, Robb GL, Chang DW (2003) Breast reconstruction in older women: advantages of autogenous tissue. Plast Reconstr Surg 111(3):1110–1121

    Article  PubMed  Google Scholar 

  11. Albornoz CR, Cordeiro PG, Pusic AL, McCarthy CM, Mehrara BJ, Disa JJ et al (2014) Diminishing relative contraindications for immediate breast reconstruction: a multicenter study. J Am Coll Surg 219(4):788–795

    Article  PubMed  Google Scholar 

  12. Laporta R, Sorotos M, Longo B, di Pompeo F (2017) Breast reconstruction in elderly patients: risk factors, clinical outcomes, and aesthetic results. J Reconstr Microsurg 33(04):257–267

    Article  PubMed  Google Scholar 

  13. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE (2017) What is polypharmacy? a systematic review of definitions. BMC Geriatr 17(1):230

    Article  PubMed  PubMed Central  Google Scholar 

  14. Deb S, Austin PC, Tu JV, Ko DT, Mazer CD, Kiss A et al (2016) A review of propensity-score methods and their use in cardiovascular research. Can J Cardiol 32(2):259–265

    Article  PubMed  Google Scholar 

  15. Walton L, Ommen K, Audisio RA (2011) Breast reconstruction in elderly women breast cancer: a review. Cancer Treat Rev 37(5):353–357

    Article  PubMed  Google Scholar 

  16. Dejean MF, Dabi Y, Goutard M, Taveau CB, Lantieri LA, Lellouch AG (2021) Deep inferior epigastric perforator free flap in elderly women for breast reconstruction: the experience of a tertiary referral center and a literature review. Breast J 27(9):700–705

    Article  PubMed  Google Scholar 

  17. Sisco M, Du H, Warner JP, Howard MA, Winchester DP, Yao K (2012) Have we expanded the equitable delivery of postmastectomy breast reconstruction in the new millennium? evidence from the national cancer data base. J Am Coll Surg. 215(5):658–666

    Article  PubMed  Google Scholar 

  18. Sada A, Day CN, Hoskin TL, Degnim AC, Habermann EB, Hieken TJ (2019) Mastectomy and immediate breast reconstruction in the elderly: trends and outcomes. Surgery 166(4):709–714

    Article  PubMed  Google Scholar 

  19. Baskin AS, Wang T, Mott NM, Hawley ST, Jagsi R, Dossett LA (2021) Gaps in online breast cancer treatment information for older women. Ann Surg Oncol 28(2):950–957

    Article  PubMed  Google Scholar 

  20. Dolen UC, Law J, Tenenbaum MM, Myckatyn TM (2022) Breast reconstruction is a viable option for older patients. Breast Cancer Res Treat 191(1):77–86

    Article  PubMed  Google Scholar 

  21. Sherman SK, Poli EC, Kapadia MR, Turaga KK (2018) Estimating surgical risk for patients with severe comorbidities. JAMA Surg 153(8):778–780

    Article  PubMed  PubMed Central  Google Scholar 

  22. Rudolph M, Moore C, Pestana IA (2019) Operative risk stratification in the obese female undergoing implant-based breast reconstruction. Breast J 25(6):1182–1186

    Article  PubMed  Google Scholar 

  23. Palve JS, Luukkaala TH, Kääriäinen MT (2020) Predictive risk factors of complications in different breast reconstruction methods. Breast Cancer Res Treat 182(2):345–354

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Mehta SK, Olawoyin O, Chouairi F, Duy PQ, Mets EJ, Gabrick KS et al (2020) Worse overall health status negatively impacts satisfaction with breast reconstruction. J Plast Reconstr Aesthetic Surg JPRAS. 73(11):2056–2062

    Article  Google Scholar 

  25. Selber JC, Bergey M, Sonnad SS, Kovach S, Wu L, Serletti JM (2009) Free flap breast reconstruction in advanced age: is it safe? Plast Reconstr Surg 124(4):1015–1022

    Article  CAS  PubMed  Google Scholar 

  26. Schwaiger K, Weitgasser L, Mahrhofer M, Bachleitner K, Abed S, Wimbauer J et al (2021) Age and overweight are not contraindications for a breast reconstruction with a TMG-flap-a risk and complication analysis of a retrospective double center study including 300 patients. J Clin Med 10(5):926

    Article  PubMed  PubMed Central  Google Scholar 

  27. Brendler-Spaeth CI, Jacklin C, See JL, Roseman G, Kalu PU (2020) Autologous breast reconstruction in older women: a retrospective single-centre analysis of complications and uptake of secondary reconstructive procedures. J Plast Reconstr Aesthet Surg 73(5):856–864

    Article  CAS  PubMed  Google Scholar 

  28. Wähmann M, Wähmann M, Henn D, Xiong L, Hirche C, Harhaus L et al (2020) Geriatric patients with free flap reconstruction: a comparative clinical analysis of 256 cases. J Reconstr Microsurg 36(2):127–135

    Article  PubMed  Google Scholar 

  29. Torabi R, Stalder MW, Tessler O, Bartow MJ, Lam J, Patterson C et al (2018) Assessing age as a risk factor for complications in autologous breast reconstruction. Plast Reconstr Surg 142(6):840e-e846

    Article  CAS  PubMed  Google Scholar 

  30. Downey L, Livingston R, Stopeck A (2007) Diagnosing and treating breast cancer in elderly women: a call for improved understanding. J Am Geriatr Soc 55(10):1636–1644

    Article  PubMed  Google Scholar 

  31. Jones EL, Leak A, Muss HB (2012) Adjuvant therapy of breast cancer in women 70 years of age and older: tough decisions, high stakes. Oncol Williston Park N. 26(9):793–801

    Google Scholar 

  32. Taylor LJ, Steiman JS, Anderson B, Schumacher JR, Wilke LG, Greenberg CC et al (2020) Does persistent use of radiation in women > 70 years of age with early-stage breast cancer reflect tailored patient-centered care? Breast Cancer Res Treat 180(3):801–807

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A et al (2017) NCCN guidelines insights: breast cancer, version 1. 2017. J Natl Compr Cancer Netw JNCCN 15(4):433–51

    Article  PubMed  Google Scholar 

  34. Derks MGM, van de Velde CJH, Giardiello D, Seynaeve C, Putter H, Nortier JWR et al (2019) Impact of comorbidities and age on cause-specific mortality in postmenopausal patients with breast cancer. Oncologist 24(7):e467–e474

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Plana-Ripoll O, Pedersen CB, Holtz Y, Benros ME, Dalsgaard S, de Jonge P et al (2019) Exploring comorbidity within mental disorders among a danish national population. JAMA Psychiat 76(3):259–270

    Article  Google Scholar 

  36. Biggs ML, Mukamal KJ, Luchsinger JA, Ix JH, Carnethon MR, Newman AB et al (2010) Association between adiposity in midlife and older age and risk of diabetes in older adults. JAMA 303(24):2504–2512

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Nwadiugwu MC (2020) Frailty and the risk of polypharmacy in the older person: enabling and preventative approaches. J Aging Res 2020:6759521

    Article  PubMed  PubMed Central  Google Scholar 

  38. Masnoon N, Kalisch Ellett L, Shakib S, Caughey GE (2020) Predictors of mortality in the older population: the role of polypharmacy and other medication and chronic disease-related factors. Drugs Aging 37(10):767–776

    Article  PubMed  Google Scholar 

  39. Topaloğlu US, Özaslan E (2020) Comorbidity and polypharmacy in patients with breast cancer. Breast Cancer Tokyo Jpn. 27(3):477–482

    Article  Google Scholar 

  40. Araco A, Caruso R, Araco F, Overton J, Gravante G (2009) Capsular contractures: a systematic review. Plast Reconstr Surg 124(6):1808–1819

    Article  CAS  PubMed  Google Scholar 

  41. Marques M, Brown SA, Oliveira I, Cordeiro MNDS, Morales-Helguera A, Rodrigues A et al (2010) Long-term follow-up of breast capsule contracture rates in cosmetic and reconstructive cases. Plast Reconstr Surg 126(3):769–778

    Article  CAS  PubMed  Google Scholar 

  42. Tamboto H, Vickery K, Deva AK (2010) Subclinical (biofilm) infection causes capsular contracture in a porcine model following augmentation mammaplasty. Plast Reconstr Surg 126(3):835–842

    Article  CAS  PubMed  Google Scholar 

  43. Fajardo LF (1989) Morphologic patterns of radiation injury. Front Radiat Ther Oncol 23:75–84

    Article  CAS  PubMed  Google Scholar 

  44. Nelson JA, Disa JJ (2017) Breast reconstruction and radiation therapy: an update. Plast Reconstr Surg 140:60S-68S

    Article  CAS  PubMed  Google Scholar 

  45. Berbers J, van Baardwijk A, Houben R, Heuts E, Smidt M, Keymeulen K et al (2014) “Reconstruction: before or after postmastectomy radiotherapy?” a systematic review of the literature. Eur J Cancer Oxf Engl 50(16):2752–62

    Article  Google Scholar 

  46. Barry M, Kell MR (2011) Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Res Treat 127(1):15–22

    Article  CAS  PubMed  Google Scholar 

  47. Alperovich M, Choi M, Frey JD, Lee ZH, Levine JP, Saadeh PB et al (2014) Nipple-sparing mastectomy in patients with prior breast irradiation: are patients at higher risk for reconstructive complications? Plast Reconstr Surg 134(2):202e-e206

    Article  CAS  PubMed  Google Scholar 

  48. Padubidri AN, Yetman R, Browne E, Lucas A, Papay F, Larive B et al (2001) Complications of postmastectomy breast reconstructions in smokers ex-smokers, and nonsmokers. Plast Reconstr Surg 107(2):342–349

    Article  CAS  PubMed  Google Scholar 

  49. Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL (2006) Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg 118(5):1100–1109

    Article  CAS  PubMed  Google Scholar 

  50. Santosa KB, Qi J, Kim HM, Hamill JB, Pusic AL, Wilkins EG (2016) Effect of patient age on outcomes in breast reconstruction: results from a multicenter prospective study. J Am Coll Surg 223(6):745–754

    Article  PubMed  PubMed Central  Google Scholar 

  51. Siotos C, Lagiou P, Cheah MA, Bello RJ, Orfanos P, Payne RM et al (2020) Determinants of receiving immediate breast reconstruction: an analysis of patient characteristics at a tertiary care center in the US. Surg Oncol 34:1–6

    Article  PubMed  Google Scholar 

  52. D’Souza N, Darmanin G, Fedorowicz Z (2011) Immediate versus delayed reconstruction following surgery for breast cancer. Cochrane Database Syst Rev 7:8674

    Google Scholar 

  53. Yoon AP, Qi J, Brown DL, Kim HM, Hamill JB, Erdmann-Sager J et al (2018) Outcomes of immediate versus delayed breast reconstruction: results of a multicenter prospective study. Breast Edinb Scotl 37:72–79

    Article  Google Scholar 

  54. Bykowski MR, Emelife PI, Emelife NN, Chen W, Panetta NJ, de la Cruz C (2017) Nipple-areola complex reconstruction improves psychosocial and sexual well-being in women treated for breast cancer. J Plast Reconstr Aesthetic Surg JPRAS. 70(2):209–214

    Article  Google Scholar 

  55. Sisti A, Grimaldi L, Tassinari J, Cuomo R, Fortezza L, Bocchiotti MA et al (2016) Nipple-areola complex reconstruction techniques: a literature review. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 42(4):441–465

    CAS  Google Scholar 

  56. Fang SY, Shu BC, Chang YJ (2013) The effect of breast reconstruction surgery on body image among women after mastectomy: a meta-analysis. Breast Cancer Res Treat 137(1):13–21

    Article  PubMed  Google Scholar 

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Funding

There are no financial conflicts of interest to disclose. No funding was received for this article.

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Authors and Affiliations

  1. Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain

    Luis Chang-Azancot, María Gijón, Nitzan Kenig, Manuel Campello, Jessica Juez, Antonio Talaya, Gregorio Gómez-Bajo & Javier Montón

  2. Geriatrics Department, Complejo Hospitalario Universitario of Albacete, Albacete, Spain

    Pedro Abizanda

  3. CIBERFES, Instituto de Salud Carlos III, Madrid, Spain

    Pedro Abizanda

  4. Anatomy and Embryology Unit, Faculty of Medicine, University of Castilla-La Mancha (UCLM), Albacete, Spain

    Javier Montón

  5. Department of Medical Oncology, Hospital Universitario 12 de Octubre, 28041, Madrid, Spain

    Rodrigo Sánchez-Bayona

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  1. Luis Chang-Azancot
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Correspondence to Luis Chang-Azancot.

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Approval was obtained from the local ethics committee (CEIM – Comité Ético de Investigación Clínica SESCAM – Albacete, Spain), reference number 2020/12/134. For this type of study, informed consent is not required.

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Chang-Azancot, L., Abizanda, P., Gijón, M. et al. Age and Breast Reconstruction. Aesth Plast Surg 47, 63–72 (2023). https://doi.org/10.1007/s00266-022-03024-0

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