Download PDF
J Reconstr Microsurg 2017; 33(04): 257-267
DOI: 10.1055/s-0036-1597822
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Breast Reconstruction in Elderly Patients: Risk Factors, Clinical Outcomes, and Aesthetic Results

Rosaria Laporta
1   Department of Plastic Surgery, “Sapienza” University of Rome, Sant'Andrea Hospital, Roma, Italy
,
Michail Sorotos
1   Department of Plastic Surgery, “Sapienza” University of Rome, Sant'Andrea Hospital, Roma, Italy
,
Benedetto Longo
1   Department of Plastic Surgery, “Sapienza” University of Rome, Sant'Andrea Hospital, Roma, Italy
,
Fabio Santanelli di Pompeo
1   Department of Plastic Surgery, “Sapienza” University of Rome, Sant'Andrea Hospital, Roma, Italy
› Author Affiliations
Further Information

Publication History

26 May 2016

16 November 2016

Publication Date:
06 January 2017 (online)

    Permissions and Reprints

Correction to:

Erratum to: Breast Reconstruction in Elderly Patients: Risk Factors, Clinical Outcomes, and Aesthetic ResultsJ Reconstr Microsurg 2017; 33(04): e1-e1
DOI: 10.1055/s-0037-1602379

Abstract

Background Correlation among age, clinical, and aesthetic outcomes in implant-based and autologous breast reconstructions was investigated.

Methods Between 2004 and 2014, a retrospective study was performed on patients who underwent reconstruction following mastectomy. Patients were divided in group A (< 50 years), group B (≥ 50–59 years), group C (≥ 60–69 years), and group D (≥ 70 years). Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and length of stay were assessed using chi-square and Kruskal–Wallis H analysis considering p ≤ 0.05 as significant. Pre- and postoperative photographs were taken to grade aesthetic results by patients and blinded plastic surgery team.

Results A total of 993 patients underwent 1,251 breast reconstructions, of which 356 (28.5%) were implant-based, 402 (32.1%) pedicled-flap, 445 (35.6%) free-flap, and 48 (3.8%) fat-graft reconstructions. There were 316 (25.2%) complications, of which 124 (34.8%) in implant-based, 74 (18.4%) in pedicled-flap, 111 (24.9%) in free-flap, and 2 (4.2%) in fat-graft reconstructions. Mean length of stay was 5.4 days without significant difference between age groups (p = 0.357). The incidence of overall complications was not significantly related to age, ASA class, smoking history, and previous radiotherapy. Body mass index was a significant predictor (p = 0.001), but odds ratio (OR: 1.2) demonstrated only a minimal increase in risk. Implant-based reconstruction was associated with a higher risk for complications compared with the other ones (OR: 2.5, p = 0.001). Patient and surgeon aesthetic surveys demonstrated an overall positive opinion in all age groups for each reconstructive option.

Conclusion Advanced age should not be considered a risk factor for breast reconstruction, while implant-based technique was associated with a higher risk for complications compared with autologous that may provide older women with greater benefits.

Keywords

Microvascular - free-tissue transfer - implant reconstruction - advanced age
 

  • References

  • 1 Howard-McNatt M, Forsberg C, Levine EA, DeFranzo A, Marks M, David L. Breast cancer reconstruction in the elderly. Am Surg 2011; 77 (12) 1640-1643
    PubMedGoogle Scholar
  • 2 Morrow M, Scott SK, Menck HR, Mustoe TA, Winchester DP. Factors influencing the use of breast reconstruction postmastectomy: a National Cancer Database study. J Am Coll Surg 2001; 192 (1) 1-8
    CrossrefPubMedGoogle Scholar
  • 3 Alderman AK, Hawley ST, Waljee J, Mujahid M, Morrow M, Katz SJ. Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer. Cancer 2008; 112 (3) 489-494
    CrossrefPubMedGoogle Scholar
  • 4 Héquet D, Zarca K, Dolbeault S , et al; Institut Curie Breast Cancer Group, Roman Rouzier. Reasons of not having breast reconstruction: a historical cohort of 1937 breast cancer patients undergoing mastectomy. Springerplus 2013; 2: 325
    CrossrefPubMedGoogle Scholar
  • 5 Xue DQ, Qian C, Yang L, Wang XF. Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol 2012; 38 (5) 375-381
    CrossrefPubMedGoogle Scholar
  • 6 Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect 2008; 70 (Suppl. 02) 3-10
    CrossrefPubMedGoogle Scholar
  • 7 Garbay JR, Rietjens M, Petit JY. Esthetic results of breast reconstruction after amputation for cancer. 323 cases [in French]. J Gynecol Obstet Biol Reprod (Paris) 1992; 21 (4) 405-412
    PubMedGoogle Scholar
  • 8 Carlson GW, Page AL, Peters K, Ashinoff R, Schaefer T, Losken A. Effects of radiation therapy on pedicled transverse rectus abdominis myocutaneous flap breast reconstruction. Ann Plast Surg 2008; 60 (5) 568-572
    CrossrefPubMedGoogle Scholar
  • 9 Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 1979; 5 (2) 257-261
    CrossrefPubMedGoogle Scholar
  • 10 Longo B, Laporta R, Sorotos M, Pagnoni M, Gentilucci M, Santanelli di Pompeo F. Total breast reconstruction using autologous fat grafting following nipple-sparing mastectomy in irradiated and non-irradiated patients. Aesthetic Plast Surg 2014; 38 (6) 1101-1108
    CrossrefPubMedGoogle Scholar
  • 11 Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas 1960; 20: 37-46
    CrossrefPubMedGoogle Scholar
  • 12 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (1) 159-174
    CrossrefPubMedGoogle Scholar
  • 13 Sisco M, Du H, Warner JP, Howard MA, Winchester DP, Yao K. 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 2012; 215 (5) 658-666 , discussion 666
    CrossrefPubMedGoogle Scholar
  • 14 Santanelli F, Longo B, Angelini M, Laporta R, Paolini G. Prospective computerized analyses of sensibility in breast reconstruction with non-reinnervated DIEP flap. Plast Reconstr Surg 2011; 127 (5) 1790-1795
    CrossrefPubMedGoogle Scholar
  • 15 Santanelli F, Longo B, Cagli B, Pugliese P, Sorotos M, Paolini G. Predictive and protective factors for partial necrosis in DIEP flap breast reconstruction: does nulliparity bias flap viability?. Ann Plast Surg 2015; 74 (1) 47-51
    CrossrefPubMedGoogle Scholar
  • 16 Colakoglu S, Khansa I, Curtis MS , et al. Impact of complications on patient satisfaction in breast reconstruction. Plast Reconstr Surg 2011; 127 (4) 1428-1436
    CrossrefPubMedGoogle Scholar
  • 17 Zhong T, McCarthy C, Min S , et al. Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: a prospective analysis of early postoperative outcomes. Cancer 2012; 118 (6) 1701-1709
    CrossrefPubMedGoogle Scholar
  • 18 Noda S, Eberlein TJ, Eriksson E. Breast reconstruction. Cancer 1994; 74 (1, Suppl): 376-380
    CrossrefPubMedGoogle Scholar
  • 19 Versaci AD, Libbey JT. Breast reconstruction following mastectomy. Obstet Gynecol Clin North Am 1994; 21 (4) 733-750
    PubMedGoogle Scholar
  • 20 Serletti JM, Higgins JP, Moran S, Orlando GS. Factors affecting outcome in free-tissue transfer in the elderly. Plast Reconstr Surg 2000; 106 (1) 66-70
    CrossrefPubMedGoogle Scholar
  • 21 Malata CM, Cooter RD, Batchelor AG, Simpson KH, Browning FS, Kay SP. Microvascular free-tissue transfers in elderly patients: the leeds experience. Plast Reconstr Surg 1996; 98 (7) 1234-1241
    CrossrefPubMedGoogle Scholar
  • 22 Lipa JE, Youssef AA, Kuerer HM, Robb GL, Chang DW. Breast reconstruction in older women: advantages of autogenous tissue. Plast Reconstr Surg 2003; 111 (3) 1110-1121
    CrossrefPubMedGoogle Scholar
  • 23 Howard MA, Cordeiro PG, Disa J , et al. Free tissue transfer in the elderly: incidence of perioperative complications following microsurgical reconstruction of 197 septuagenarians and octogenarians. Plast Reconstr Surg 2005; 116 (6) 1659-1668 , discussion 1669–1671
    CrossrefPubMedGoogle Scholar
  • 24 Santanelli F, Longo B, Sorotos M, Farcomeni A, Paolini G. Flap survival of skin-sparing mastectomy type IV: a retrospective cohort study of 75 consecutive cases. Ann Surg Oncol 2013; 20 (3) 981-989
    CrossrefPubMedGoogle Scholar
  • 25 Davies K, Allan L, Roblin P, Ross D, Farhadi J. Factors affecting post-operative complications following skin sparing mastectomy with immediate breast reconstruction. Breast 2011; 20 (1) 21-25
    CrossrefPubMedGoogle Scholar
  • 26 Selber JC, Bergey M, Sonnad SS, Kovach S, Wu L, Serletti JM. Free flap breast reconstruction in advanced age: is it safe?. Plast Reconstr Surg 2009; 124 (4) 1015-1022
    CrossrefPubMedGoogle Scholar
  • 27 Chang EI, Vaca L, DaLio AL, Festekjian JH, Crisera CA. Assessment of advanced age as a risk factor in microvascular breast reconstruction. Ann Plast Surg 2011; 67 (3) 255-259
    CrossrefPubMedGoogle Scholar
  • 28 Jeong HS, Miller TJ, Davis K , et al. Application of the Caprini risk assessment model in evaluation of non-venous thromboembolism complications in plastic and reconstructive surgery patients. Aesthet Surg J 2014; 34 (1) 87-95
    CrossrefPubMedGoogle Scholar
  • 29 Pannucci CJ, Barta RJ, Portschy PR , et al. Assessment of postoperative venous thromboembolism risk in plastic surgery patients using the 2005 and 2010 Caprini risk score. Plast Reconstr Surg 2012; 130 (2) 343-353
    CrossrefPubMedGoogle Scholar
  • 30 Caprini JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. Am J Surg 2010; 199 (1, Suppl): S3-S10
    Google Scholar
  • 31 Thromboembolism Risk. Diepflap.it Medical Software (Version 1.2) [Mobile application software]. Available at: https://itunes.apple.com/it/app/thromboembolism-risk/id889719436?l=en&mt=8 . Retieved 2014
    PubMedGoogle Scholar
  • 32 Butz DR, Lapin B, Yao K , et al. Advanced age is a predictor of 30-day complications after autologous but not implant-based postmastectomy breast reconstruction. Plast Reconstr Surg 2015; 135 (2) 253e-261e
    CrossrefPubMedGoogle Scholar
  • 33 Alperovich M, Choi M, Frey JD , et al. Nipple-sparing mastectomy in patients with prior breast irradiation: are patients at higher risk for reconstructive complications?. Plast Reconstr Surg 2014; 134 (2) 202e-206e
    CrossrefPubMedGoogle Scholar
  • 34 Yueh JH, Houlihan MJ, Slavin SA, Lee BT, Pories SE, Morris DJ. Nipple-sparing mastectomy: evaluation of patient satisfaction, aesthetic results, and sensation. Ann Plast Surg 2009; 62 (5) 586-590
    CrossrefPubMedGoogle Scholar
  • 35 Maass SW, Bagher S, Hofer SO, Baxter NN, Zhong T. Systematic review: aesthetic assessment of breast reconstruction outcomes by healthcare professionals. Ann Surg Oncol 2015; 22 (13) 4305-4316
    CrossrefPubMedGoogle Scholar
  • 36 Visser NJ, Damen TH, Timman R, Hofer SO, Mureau MA. Surgical results, aesthetic outcome, and patient satisfaction after microsurgical autologous breast reconstruction following failed implant reconstruction. Plast Reconstr Surg 2010; 126 (1) 26-36
    PubMedGoogle Scholar