title: Immediate breast reconstruction in the elderly: can it be considered an integral step of breast cancer treatment? The experience of the European Institute of Oncology, Milan.
abstract: BACKGROUND
  In the last few decades, breast reconstruction often has not been offered to the elderly population due to the reluctance of clinicians concerned about serious co-morbidities. This study aims to demonstrate that breast reconstruction is feasible and safe in the elderly cohort.
  
  
  METHODS
  Between 1999 and 2004, 63 elderly patients underwent an immediate reconstruction after breast cancer treatment at the European Institute of Oncology. A conservative treatment, combined with breast repair by plastic surgical techniques, was performed in 14 patients. In the remaining 49 patients, a modified radical mastectomy was necessary in 30 breasts, a total mastectomy in 19, a subcutaneous mastectomy in one case and a radical mastectomy in one patient. Three nipple-sparing mastectomies, along with intra-operative radiotherapy, were performed in two patients. A definitive silicone implant was used in 41 breasts and a skin expander in eight cases. A latissimus dorsi flap was performed in two patients, a pedicled transverse rectus abdominis muscle (TRAM) flap in two cases and a local advancement fasciocutaneous flap in another two patients.
  
  
  RESULTS
  In all patients, surgery was well tolerated despite patient age. No systemic and medically unfavourable events occurred in the immediate and late postoperative period. Infection occurred in four patients (6.34%) and partial necrosis of the mastectomy flaps in three cases (5.5% of the mastectomies). Capsular contracture grade III and IV was reported in four cases (8.89%). Total implant removal was rated 12.24%, due to infection (three prostheses), exposure (one expander) and capsular contracture grade IV (two implants).
  
  
  CONCLUSIONS
  Implant-based technique of breast reconstruction should be made available to the elderly population.
authors.affiliation: Department of Plastic and Reconstructive Surgery, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy. francesca.delorenzi@ieo.it
authors.forename: Francesca
authors.initials: F
authors.lastname: De Lorenzi
authors.forename: Mario
authors.initials: M
authors.lastname: Rietjens
authors.forename: Massimo
authors.initials: M
authors.lastname: Soresina
authors.forename: Fabio
authors.initials: F
authors.lastname: Rossetto
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bosco
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Vento
authors.forename: Simonetta
authors.initials: S
authors.lastname: Monti
authors.forename: Jean Y
authors.initials: JY
authors.lastname: Petit
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D016462:Mammaplasty; D008408:Mastectomy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome