Older and younger women benefit equally from breast reconstruction after mastectomy

October 26, 2016

The most comprehensive study of its kind to date found that older women enjoy the same benefits from breast reconstruction following mastectomy for breast cancer as younger women without a significant increase in the risk for complications. As with patients across all age groups, the benefits of breast reconstruction must be weighed against the risks. However, these study results showed that the procedure was successful in the vast majority of cases and that age alone should not disqualify a woman from undergoing a reconstruction procedure.

The study, published online in the Journal of the American College of Surgeons in advance of print publication, evaluated clinical and patient-reported outcomes two years after women underwent mastectomy and for breast cancer. The study included 1,531 women who had the surgery at one of 11 institutions in the US and Canada that participated in the Mastectomy Reconstruction Outcomes Consortium (MROC) study.

MROC is a prospective, long-term, National Cancer Institute-funded study focused on outcomes associated with various types of breast reconstruction in different patient populations. MROC recruited between February 2012 and July 2016.

Of the nearly 250,000 women to be diagnosed with breast cancer in 2016, 40 percent will be 62 years of age or older.1 Although the use of mastectomy in the treatment of has increased over the last 10 years,2 older women are less likely to have the procedure than younger ones.3

Previous studies that examined the use of breast reconstruction in women of different age groups have been hampered by study design or size. Studies have been small and confined to patients treated in a single clinical institution, so their findings do not apply to other patient populations that receive treatment in other clinical settings. Many studies have not included patient-reported outcomes that determine satisfaction and quality of life following surgery, or they assessed complication rates only in the period immediately following surgery, according to Edwin G. Wilkins, MD, principal author, and professor of surgery in the section of plastic surgery, University of Michigan Health System, Ann Arbor.

The present study was not only large in size and multi-institutional; it assessed outcomes over a long term. It also was prospective in nature. "Most previous studies provided just a snap-shot in time. They looked retrospectively at the previous 10 years, identified patients who had breast reconstruction, and then studied them. This study started before the patients had reconstruction and followed them for two years afterward. It essentially studied all patients over the same interval. It provided a baseline measurement of body image, quality of life, and overall health because where a patient is before surgery has a large effect on where she ends up two years later," Dr. Wilkins said.

The study categorized patients by age group: 494 were younger (less than 45 years of age); 803 were middle-aged (between 45 and 60 years); and 234 were older (more than age 60). The investigators determined overall rates for any type of complication as well as any major complication that required hospital admission or surgical exploration.

In addition, the investigators compiled information about patient-reported outcomes using the BREAST-Q Reconstructive Module. BREAST-Q is a validated data-gathering instrument that has been widely used to assess patient satisfaction and patients' perceptions of psychosocial, physical, and sexual well-being following breast reconstruction.

Complication rates varied by surgical procedure (i.e., insertion of a surgical implant vs. use of a patient's own tissue). Among women who received a surgical implant, the rate for any complication was 22 percent in the younger age group, 27 percent in the middle-aged group, and 29 percent in the older group. The rate for a major complication among women who had an autologous procedure was 33 percent in , 29 percent in the middle-aged, and 31 percent in older women.

Only one group of women expressed a slight decline in their satisfaction after breast reconstruction. Older women who had implant surgery had a BREAST-Q satisfaction score of 60.9 preoperatively and a score of 59.2 afterward. All other groups of women were just as satisfied with their breasts after reconstruction as they were before undergoing the procedure. "Breast reconstruction has been described as a 'reverse mastectomy.' Given the findings from our study, it's hard to dispute that contention, regardless of age," Dr. Wilkins said.

"Surgeons and patients may have preconceived notions that breast reconstruction is not as good an option in as it is in younger patients. According to findings from this study, reconstruction provided the benefits it was expected to provide for quality of life and body image, and age did not significantly affect complications," Dr. Wilkins said.

Study coauthors include Katherine B. Santosa, MD; Ji Qi, MS; Hyungjin M. Kim, ScD; Jennifer B. Hamill, MPH; Andrea L. Pusic, MD, FACS.

Explore further: Breast reconstruction after cancer using abdominal tissue

More information: Katherine B. Santosa et al, Effect of Patient Age on Outcomes in Breast Reconstruction: Results from a Multicenter Prospective Study, Journal of the American College of Surgeons (2016). DOI: 10.1016/j.jamcollsurg.2016.09.003

1. Howlader N, et al. SEER Cancer Statistics Review, 1975-2013. National Cancer Institute. Bethesda, MD; 2016.

2. Feigelson HS et al. Treatment patterns for ductal carcinoma in situ from 2000-2010 across six integrated health plans. Springerplus. 2015;4:24.

3. Butler PD, et al. Racial and age disparities persist in immediate breast reconstruction: an updated analysis of 48,564 patients from 2005 to 2011. American College of Surgeons National Surgery Quality Improvement Program data sets. Am J Surg. 2016 Jul;212(1):96-101.

Related Stories

Breast reconstruction after cancer using abdominal tissue

October 20, 2016
In addition to being faced with the diagnosis of breast cancer, many women also are faced with making several important decisions, including whether to have breast reconstruction surgery. According to a plastic surgeon who ...

No increase in complications of breast reconstruction over age 65

January 28, 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.

Immediate breast reconstruction reduces psychological impact of mastectomy

September 29, 2016
Immediate breast reconstruction (IBR) can avoid some of the psychological effects of undergoing mastectomy for breast cancer, compared to waiting for delayed breast reconstruction (DBR), reports a study in the October issue ...

Good long-term quality of life after 'DIEP flap' breast reconstruction

April 29, 2016
For women who have undergone mastectomy for breast cancer, breast reconstruction using the abdominal "DIEP flap" provides good long-term quality of life (QOL)—similar to that of women without breast cancer, reports a study ...

Breast reconstruction using patient's own tissues yield higher satisfaction rates

December 29, 2014
For women who have undergone mastectomy, breast reconstruction using the patient's own tissues—rather than implants—provides higher satisfaction scores, reports a study in the January issue of Plastic and Reconstructive ...

Racial disparity in breast reconstruction? African-American women more likely to undergo autologous reconstruction

August 1, 2016
African American women undergoing mastectomy for breast cancer are more likely than white women to undergo autologous breast reconstruction using their own tissue, rather than implant-based reconstruction, reports a study ...

Recommended for you

Smoking raises risk of aneurysm recurrence after endovascular treatment

August 17, 2017
In a new study, researchers report people who have experienced an aneurysm have another reason to quit smoking.

Study adds to evidence that most prescribed opioid pills go unused

August 2, 2017
In a review of half a dozen published studies in which patients self-reported use of opioids prescribed to them after surgery, researchers at Johns Hopkins report that a substantial majority of patients used only some or ...

Engineers harness the power of 3-D printing to help train surgeons, shorten surgery times

August 2, 2017
A team of engineers and pediatric orthopedic surgeons are using 3D printing to help train surgeons and shorten surgeries for the most common hip disorder found in children ages 9 to 16. In a recent study, researchers showed ...

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.