Women diagnosed with breast cancer can decide to undergo post-mastectomy breast reconstruction (PMBR) after the surgery. The necessity of using reconstructive surgery is to enhance the quality of life which has been known for a long time, but the opinion about age that can impact the postsurgical outcomes remains indeterminate.
Contemporary publications agree with the notion that age should not be a deciding factor in whether to undergo breast reconstruction. However, it has left the relationship between age complication rates, and patient-reported outcomes (PROs) as areas of considerable uncertainty. The purpose of this study is to understand whether age plays a role in complications and changes in PROs, assessed through the BREAST-Q, after PMBR within the next five years.
The current study involved a retrospective cohort analysis of patients who received either implant-based reconstruction (IBR) or autologous breast reconstruction (ABR) for PMBR. A total of 4730 patients were considered within the study, out of them 1536 (32.5%) patients were treated under the ABR setting while 3194 (67.5%) patients received IBR.
Outcome measures used in the study included postoperative complications like mastectomy skin flap/nipple necrosis, infection, and seroma, and the BREAST-Q scores. BREAST-Q is a standardized tool that measures different domains such as satisfaction with breasts, psychosocial well-being, physical well-being of the chest region, and sexual well-being.
The study cohort of 4730 patients revealed that IBR was preferred by 67.5% of the patients. It was significant that the higher the age, the higher the risk of developing several complications. Elder patients had significantly more skin flap/nipple necrosis, infection, and seroma compared to young patients.
The PROs that showed a remarkable correlation with age were the satisfaction with breasts, which had a negative correlation (95% confidence interval (CI) is −0.12 to −0.01; β (regression coefficient) is −0.06; P = 0.033), indicated by the fact that older patients reported lower levels of satisfaction with the appearance of their reconstructed breasts. The group being older had a positive correlation with psychosocial well-being (95% CI is 0.09 to 0.20; β = 0.14; P < 0.001), more so, the older patients expressed more positive emotions. Considering these outcomes, the authors said that older patients may be less satisfied with the aesthetic appearance of the reconstructed breast, but they are likely to gain more psychological health advantages from the procedure.
Thus, the physical well-being of the chest was not associated with age (95% CI is −0.08, 0.02; β = −0.03, P = 0.2), and sexual well-being (95% CI: −0.12, 0.02; β = −0.04, P = 0.2). Interestingly, age was found to impact parts of this postmastectomy experience, but it does not significantly contribute to the patient’s physical rehabilitation or the sexual health of women.
Secondary analysis of variance showed that there were differences between ABR and IBR patients. The results from the ABR group showed that patients with an older age had more complications, especially those related to wound healing compared to the patients in the IBR group.
Overall, this research is informative in understanding the interactive effects of age on postoperative outcomes following breast reconstruction. Older patients have higher complication rates, it is believed that with age, the skin loses its elasticity; the blood vessels in the skin are less and if they are injured; wound healing takes longer than in young patients. These factors could contribute to the increased rate of mastectomy skin flap and/or nipple necrosis, postoperative infection, and seroma formation in this group of patients. It will be important that the surgeon proposing reconstructive surgery considers these age-related risks and adopt measures to reduce complications such as more frequent examinations and using the most up-to-date wound healing methods.
Another interesting insight obtained from the analysis is a positive dynamic between older age and psychosocial well-being. It indicates that although the patients may be unhappy with the aesthetic outcome, the mental and psychological aspects can be rewarding for the older patient who opts for reconstruction. This might be caused by the following reasons: confidence derived from good body image and the feeling of coming to an end with cancer treatment may overshadow the importance attached to physical gains.
Age should be taken into consideration when discussing PMBR. It may also be that older patients have higher rates of complications and lower satisfaction with the aesthetic outcome of the breast, but they enjoy improved psychosocial functioning after the surgery.
References: Kim M, Ali B, Zhang K, et al. Age impacts clinical and patient-reported outcomes following postmastectomy breast reconstruction. Plast Reconstr Surg. 2024;155(1). doi:10.1097/PRS.0000000000011554
