Age may not affect breast reconstruction complications

(Reuters Health) – Despite concerns, older women don’t have more complications with breast reconstruction procedures than younger women, a new U.S. study suggests.

In fact, researchers found, women over age 60 had better sexual, physical and psychosocial wellbeing than younger women after a type of reconstruction procedure that uses a woman’s own tissue to rebuild the breast.

“There is still a lingering bias among both patients and doctors that once you get to a certain age, reconstruction becomes riskier,” said senior study author Edwin Wilkins, a professor of plastic surgery at the University of Michigan in Ann Arbor. “Anecdotally, in my own practice, I have not found that to be the case.”

“We can’t make patients look like nothing happened, but we can give them, in most cases, a result that improves their body image and contributes to quality of life,” Wilkins said. “Those benefits aren’t limited to a certain age group.”

About 250,000 U.S. women will be diagnosed with breast cancer in 2016, and 40 percent of them will be older women, according to the National Cancer Institute. The median age of breast cancer diagnosis is now 62.

As survival rates improve, more women are living longer after breast cancer treatment and more are seeking mastectomies and breast reconstruction, the study authors write in the Journal of the American College of Surgeons. Despite this trend, women over 60 are less likely to receive reconstruction.

The researchers looked at two-year complication rates such as hospital readmission and implant removal as well as patient-reported outcomes such as breast satisfaction and sexual wellbeing among 1,531 patients who had reconstruction at 11 institutions in the U.S. and Canada between 2012 and 2014.

Patients were split into three age groups: younger than 45 years old, 45 to 60 and older than 60.

Older women had higher sexual wellbeing scores than middle-aged and younger women with both implant and so-called autologous procedures that use the woman’s own tissue instead of an implant. Although older women also had better psychosocial and physical wellbeing with autologous procedures, there was no difference between the age groups in those categories with implant procedures.

“This study is really important because more women are having mastectomies and the decision about reconstruction is becoming more common,” said Clara Lee of Ohio State University in Columbus who was not involved with the study. “Plastic surgeons have been saying, ‘research suggests this,’ but now they can have more confidence when counseling patients.”

Few previous studies have assessed post-mastectomy breast reconstruction in older women, particularly with patient-related outcomes such as satisfaction, Lee told Reuters Health. In addition, most studies look at 30 days post-reconstruction, rather than two years.

“This study looks at outcomes in a rigorous way and has a longer follow-up than almost any study in this area,” Lee noted. “Women don’t just care what happens to them in 30 days. They care going forward.”

The complication rates, which ranged from 15 to 30 percent, are “nothing to sneeze at,” Lee added. These rates were generally higher in women undergoing autologous reconstruction than implant procedures, but two-year reconstruction failure rates were lower with autologous procedures than with implants.

Differences between women who had different types of reconstruction are among the study’s limitations. For example, the younger cohort had many more bilateral mastectomies than the other two groups, said Emily Bellavance of the University of Maryland Medical Center in Baltimore, who wasn’t involved with the study.

“We know that the complication rates of bilateral mastectomy with reconstruction compared with unilateral construction can be two to three times higher,” she told Reuters Health by email.

Ultimately, breast cancer patients should have as much information as possible about complications, outcomes and satisfaction rates, Wilkins said.

“Women choose what works best for them, and we as health care providers need to respect that,” he said. “Breast cancer patients are smart, and we should give them the information they need to make the best choices based on their own preferences and values.”

SOURCE: Journal of the American College of Surgeons, online October 26, 2016.