A study analyzing breast cancer patients who underwent breast reconstruction surgery after mastectomy procedures found that both older and younger women enjoy the same benefits without significantly higher risks of complications.
The study, “Effect of Patient Age on Outcomes in Breast Reconstruction: Results from a Multicenter Prospective Study,” was published online in the Journal of the American College of Surgeons.
Researchers assessed clinical and patient-reported outcomes two years after 1,531 women underwent mastectomy and breast reconstruction surgery at one of the 11 North American centers that participated in the Mastectomy Reconstruction Outcomes Consortium (MROC) study (NCT01723423) between 2012 and 2016.
MROC is a National Cancer Institute (NCI)-funded prospective, long-term effort focused on the outcomes associated with different types of breast reconstruction in different patient populations. About 40 percent of the 250,000 women diagnosed with breast cancer in 2016 were 62 or older, and older women are less to undergo a mastectomy than younger women.
Results showed that breast reconstruction is successful in the vast majority of cases, and age alone should not be a disqualifying factor when deciding on the procedure.
Researchers analyzed two-year complications and patient-reported outcomes using the BREAST-Q Reconstructive Module — a data-gathering measure to assess patient satisfaction and perception of psychosocial, physical, and sexual well-being after breast reconstruction — by comparing responses from younger (494 women under age 45), middle-aged (803 women, ages 45 to 60 ) and older (234 women, age 61 or older) women. The investigators also determined overall rates of complications, including those requiring hospital admission or surgery.
“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 afterwards,” Edwin G. Wilkins, with the Department of Surgery at the University of Michigan and the study’s principal author, said in a press release. “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.”
The researchers found that complication rates varied by type of surgical procedure: for surgical implants, complication rates were at 22% in the younger age group, 27% in the middle-age group, and 29% in the older age group. For autologous procedure, which used a women’s own tissue to form a breast, complication rates were at 33% in younger women, 29% in middle-age women and 31% in older women.
Older women who underwent an implant did show a slight decline in satisfaction with reconstruction surgery, with their BREAST-Q satisfaction score dropping from 60.9 before surgery to 59.2 after the surgery. The two remaining groups reported satisfaction rates both before and after the procedure.
But older women reported higher sexual well-being scores after either procedure — implant or autologous — and those who underwent autologous procedures reported higher physical and psychosocial well-being scores than younger women, the researchers reported. No difference among the age groups was seen with regard to physical and psychosocial well-being in those who had implant procedures.
“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,” added Wilkins. “Surgeons and patients may have preconceived notions that breast reconstruction is not as good an option in older women 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.”
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