Aging & Longevity
Being senior citizen does not add
complications to breast reconstruction
But problems with blood clots may be
more common in older women, study suggests
2, 2015 - Older women don't have an increased overall risk of
complications from breast reconstruction after mastectomy, reports the
February issue of Plastic and Reconstructive Surgery, official journal
of the American Society of Plastic Surgeons.
"Older patients should be counseled
that their age does not confer an increased risk of complications after
implant-based post-mastectomy breast reconstruction," concludes the
study by ASPS member surgeon Mark Sisco, MD, of North Shore University
Health System and University of Chicago and colleagues.
However, the results do suggest
that women aged 65 or older are at increased risk of blood clot-related
complications after tissue-based breast reconstruction.
No Difference in Overall
Complications by Age...
Using a national surgery database,
the researchers identified nearly 41,100 women who had unilateral
mastectomy (removal of one breast) between 2005 and 2012. Of these,
about 11,800 patients underwent breast reconstruction.
Women aged 65 or older were less
likely to have breast reconstruction: 10.8 percent, compared to 39.5
percent for younger women.
Compared to mastectomy only, women
undergoing breast reconstruction had more complications, including
increased hospital days and repeat surgeries.
The complication rate after breast
reconstruction was 6.8 percent for older women and 5.2 percent for
The overall risk of complications
did not differ significantly between age groups, after adjustment for
other factors. The risk remained the same for older and younger women
undergoing breast reconstruction using implants.
But Higher VTE Risk in Older
Women after Autologous Reconstruction
However, after autologous
reconstruction--creation of a new breast using the patient's own
tissues¬--the risk of blood clot-related complications called venous
thromboembolism (VTE) was significantly higher for older women. VTE is a
common and serious condition in which blood clots form in the leg or
other veins (deep vein thrombosis) or lung (pulmonary embolism).
On adjusted analysis, VTE risk was
nearly four times higher in women aged 65 or older, and more than six
times higher for those aged 70 to 75. The overall rate of VTE after
autologous reconstruction was just under one percent. Other types of
complications were similar between age groups.
Breast reconstruction "is an
important option for women undergoing mastectomy and may improve patient
self-esteem, body image, and quality of life," the researchers write.
Older women are much less likely to undergo breast
reconstruction--partly because of a perceived increase in surgical risk.
While older women may have reasons
for not undergoing breast reconstruction, there's little evidence on how
age affects complication risk. "As such, it is impossible for older
women to make informed decisions about the risks and benefits of
post-mastectomy breast reconstruction that take into account their age,"
according to Dr. Sisco and colleagues.
The new study shows a similar
overall complication rate for older versus younger women undergoing
breast reconstruction. "Older women considering implant-based
reconstruction should be assured that their age is not a factor in
determining the risk of complications," the researchers write.
"However, they should be counseled
that their age may confer an increased risk of VTE," Dr. Sisco and
coauthors add. They suggest that older women may need special attention
to preventing VTE after autologous breast reconstruction--possibly
including longer use of blood-thinning medications.
Plastic and Reconstructive Surgery (Journal)
American Society of Plastic Surgeons (ASPS)