title: Breast cancer in women under age 40 years: treatment by total mastectomy and reconstruction.
abstract: BACKGROUND
  Breast cancer in women under 40 years of age is rare, accounting for approximately 5% of cases. The disease tends to be more aggressive in younger women. Younger age has been shown to be an independent predictive of breast reconstruction after total mastectomy. Treatment by total mastectomy and reconstruction is examined in relation to patient age.
  
  
  METHODS
  A retrospective review of all breast cancer patients treated by total mastectomy and reconstruction between 2005 and 2009 was performed by querying a prospective database.
  
  
  RESULTS
  A total of 671 patients underwent total mastectomy and reconstruction; of them, 106 (16%) aged <40 and 565 (84%) aged ≥40 years. Compared with older patients, the age <40 group was more likely to present with advanced breast cancer (P < 0.001), receive radiation (P = 0.006), undergo contralateral prophylactic mastectomy (P < 0.001) and bilateral reconstruction (P = 0.005), and undergo delayed reconstruction (P = 0.02). Transverse rectus abdominis musculocutaneous flap reconstruction was more common in the age ≥40 years (P = 0.03). Bilateral reconstruction was most commonly performed with tissue expansion regardless of patient age.
  
  
  CONCLUSIONS
  Breast reconstruction in women less than 40 years of age is influenced by advanced tumor stage and the necessity for adjuvant radiation therapy as well as an increased use of contralateral prophylactic mastectomy.
authors: Division of Plastic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors: Jeffery E
authors: JE
authors: Vogel
authors: Carrie
authors: C
authors: Chu
authors: Meghan
authors: M
authors: McCullough
authors: Erica
authors: E
authors: Anderson
authors: Albert
authors: A
authors: Losken
authors: Grant W
authors: GW
authors: Carlson
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D015413:Mastectomy, Simple / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome