Older women undergoing breast reconstruction may have increased risks for complications

For women undergoing breast reconstruction after mastectomy, older age is associated with small but significant increases in certain complications, reports a study in the January issue of Plastic and Reconstructive Surgery^®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

Older women may be less satisfied with the appearance of the reconstructed breasts, but may have better psychologic adjustment after breast reconstruction compared to younger patients, according to the new research by Jonas A. Nelson, MD, MPH, and colleagues of Memorial Sloan Kettering Cancer Center, New York. "These findings clarify how age affects the outcomes of breast reconstruction, which may help in minimizing the risks and maximizing the benefits for older women considering reconstructive surgery after mastectomy," Dr. Nelson comments.

Increased complications of breast reconstruction in older women

Breast reconstruction has important benefits for women undergoing mastectomy for treatment of breast cancer. Previous studies have suggested that age "should not be a deterring factor" to post-mastectomy breast reconstruction (PMBR), but the true impact of age on patient outcomes remains unclear. While about one-half of patients undergo breast reconstruction after mastectomy, only about six percent are older than 60 years.

Toward "a more thorough and rigorous assessment" of how age affects breast reconstruction outcomes, Dr. Nelson and colleagues analyzed 4,730 patients who underwent PMBR at the authors' cancer center between 2017 and 2022. After adjustment for other factors, older patients were at higher risk of three types of complications: infection, breakdown (necrosis) of the skin flap used for reconstruction, and fluid buildup (seroma) under the wound.

For all three complications, risk increased slightly per year of age. For every 10-year increase in age, infection risk increased by 10% while skin necrosis and seroma risk increased by 20%.

Mixed effects of age on patient-reported outcomes of PMBR

The study also looked at how age affected patient satisfaction and quality-of-life outcomes, assessed using the validated BREAST-Q questionnaire. Older age was associated with lower scores in satisfaction with the breasts, such as the natural appearance of the breasts and clothing fit.

In contrast, older age was linked to higher scores for psychosocial well-being, addressing factors such as body image and confidence in social settings. The researchers suggest that older patients may have fewer concerns about factors such as their career and finances, and a more "matter-of-fact" attitude toward aging and their cancer diagnosis. Age was unrelated to physical well-being related to the chest, such as pain or activity limitations, or to sexual well-being.

Subgroup analyses suggested some differences in complications and patient-reported outcomes for women undergoing implant-based reconstruction versus autologous reconstruction using the patients' own tissues. There were also differences in outcomes for older women who had other health conditions associated with frailty.

Our findings suggest that age should be considered alongside other factors when determining whether an older patient is a suitable candidate for breast reconstruction."

Dr. Jonas A. Nelson, MD, MPH, Memorial Sloan Kettering Cancer Center

The increased complication rates associated with older age may reflect risk factors such as high blood pressure and diabetes. The researchers suggest that optimized care for these conditions might help to reduce the risk of complications.

The study also provides insights into age-related differences in patient-reported outcomes – viewed as an important factor in assessing the benefits versus risks of breast reconstruction. Dr. Nelson adds: "This comprehensive analysis may also help to maximize postoperative physical functioning and patient satisfaction among older women who opt for PMBR."