Breast Reconstruction in Older Patients

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Prospective randomized trials addressing the safety of breast reconstruction in the older patient population don’t exist, and are unlikely to take place in the future
  • The available literature largely consists of single institution experiences with various types of breast reconstruction in older patients
  • This data shows that, in the older breast cancer patients determined to be good candidates for breast reconstruction:
    • The latter is generally safe in this patient population
  • A study by Sada et al from the Mayo Clinic reported that, among women 65 years and older who underwent immediate breast reconstruction:
    • 12.6% experienced postoperative complications
    • Whereas women younger than 65 had a lower complication rate of 6.8% (p=0.04)
    • Similarly, older patients undergoing immediate breast reconstruction:
      • Were more likely to require a reoperation for postoperative hematoma:
        • 5.3% vs. 0.9%, p=0.006
    • It is reassuring that complication rates are quite low overall, and there were no differences between older and younger patients undergoing breast reconstruction with respect to skin flap necrosis or unplanned readmission
  • Autologous breast reconstruction performed in carefully selected patients 65 years and older has also been reported to be safe and successful, as has been shown in a single institution report by Brendler-Spaeth et al, and in another retrospective series by Wähmann et al
  • Additionally, Brendler-Spaeth et al reported that immediate and delayed autologous breast reconstruction in older breast cancer patients was associated with similarly low complication rates
  • Furthermore, autologous breast reconstruction was shown to be associated with better long-term aesthetic outcomes in older breast cancer patients based on the meta-analysis by Hamnett and Subramanian
  • Rates of breast reconstruction in elderly patients are lower than among younger patients:
    • Approximately 1% versus 45%, respectively
  • A single institution study by Siotos et al demonstrated that older age was an independent risk factor for not receiving breast reconstruction (OR=0.18, 95%CI:0.08-0.40)
  • The existing literature is limited in that it is not possible to discern whether older patients are not being offered breast reconstruction as often as their younger counterparts or if they are less likely to opt for it
  • The available data demonstrate rather low complication rates reported in older breast cancer patients undergoing breast reconstruction, and they underscore an opportunity to extend the option of breast reconstruction to older patients interested in pursuing it and deemed to be good surgical candidates
  • References
    • Dolen UC, Law J, Tenenbaum MM, Myckatyn TM. Breast reconstruction is a viable option for older patients. Breast Cancer Res Treat. 2022;191(1):77-86. doi: 10.1007/s10549-021-06389-z
    • Chang-Azancot L, Abizanda P, Gijón M, et al. Age and breast reconstruction. Aesth Plast Surg. 2023;47(1):63-72. doi: 10.1007/s00266-022-03024-0
    • Sada A, Day CN, Hoskin TL, Degnim AC, Habermann EB, Hieken TJ. Mastectomy and immediate breast reconstruction in the elderly: trends and outcomes. Surgery. 2019;166(4):709-714. doi: 10.1016/j.surg.2019.05.055
    • Brendler-Spaeth CI, Jacklin C, See JL, Roseman G, Kalu PU. Autologous breast reconstruction in older women: a retrospective single-centre analysis of complications and uptake of secondary reconstructive procedures. J Plast Reconstr Aesthet Surg. 2020;73(5):856-864. doi: 10.1016/j.bjps.2019.11.039
    • Wähmann M, Wähmann M, Henn D, et al. Geriatric patients with free flap reconstruction: a comparative clinical analysis of 256 cases. J Reconstr Microsurg. 2020;36(2):127-135. doi: 10.1055/s-0039-1697646
    • Hamnett KE, Subramanian A. Breast reconstruction in older patients: a literature review of the decision-making process. J Plast Reconstr Aesthet Surg. 2016;69(10):1325-1334. doi: 10.1016/j.bjps.2016.06.003
    • Lee RXN, Cardoso MJ, Cheung KL, Parks RM. Immediate breast reconstruction uptake in older women with primary breast cancer: a systematic review. Br J Surg. 2022; 109(11):1063-1072. doi: 10.1093/bjs/znac251
    • Siotos C, Lagiou P, Cheah MA, et al. Determinants of receiving immediate breast reconstruction: an analysis of patient characteristics at a tertiary care center in the US. Surg Oncol. 2020;34:1-6. doi: 10.1016/j.suronc.2020.02.017
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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