August 29, 2019
By Will Boggs MD
NEW YORK (Reuters Health) - Postoperative-complication rates after mastectomy with immediate breast reconstruction are higher for women aged 65 years and older than for younger women, according to a database study.
"While 78% of women younger than age 65 treated with mastectomy over the recent 5-year study period underwent immediate breast reconstruction compared to only 28% of women aged 65 and older, suggesting that older women having immediate breast reconstruction were highly selected, it was surprising that we still found a statistically significantly higher complication rate among the older patients, despite the overall low complication rate," Dr. Tina J. Hieken from Mayo Clinic, in Rochester, Minnesota, told Reuters Health by email.
Immediate breast reconstruction (IBR) after mastectomy improves quality of life and body image, but only about one in six women aged 65 years and older diagnosed with breast cancer undergo mastectomy with IBR.
Dr. Hieken's team used their institutional breast-surgery database to analyze postmastectomy complications after 1,721 mastectomies in 1,698 women, including 408 mastectomies in women 65 years and older.
About two-thirds (65.6%) of the entire study group had a mastectomy with IBR, and fewer elderly women (27.6%) than younger women (77.1%) underwent IBR, the researchers report in Surgery, online August 5.
For mastectomy alone, postoperative complication rates did not differ significantly between older (6.4%) and younger (3.9%) patients (P=0.18). But the overall complication rate for women undergoing IBR was nearly twice as high in the older group (12.6%) as in the younger group (6.8%) (P=0.04).
"While the absolute differences in postoperative complication rates between younger and older women were small, we report on complications requiring treatment and these differences are clinically meaningful," Dr. Hieken said. "For example, hematomas requiring reoperation were seen more than 5 times more frequently in older than younger women."
"We recommend disclosing the greater risk of suffering a postoperative complication to older women to help each woman make a fully informed choice regarding her breast cancer treatment or risk-reduction plan," she said.
"Better metrics to further refine patient selection for the more complex operation (mastectomy with immediate reconstruction) would be valuable, especially as the general population ages and, in parallel, the median age of diagnosis of breast cancer continues to increase," Dr. Hieken added.
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