title: Breast cancer reconstruction in the elderly.
abstract: Mastectomy is a surgical choice for breast cancer, yet breast reconstruction is underused in women older than age 60 years. Because of a paucity of information examining breast cancer reconstruction in the elderly, we sought to review our experience. By retrospective chart review, we  evaluated 89 women older than 60 years having mastectomy and reconstruction from January 1998 to June 2008. Mean patient age was 65 years (range, 60 to 74 years). The majority (41%) had Stage 1 disease or Stage 2 (30%). Ductal carcinoma in situ comprised 25 per cent and Stage 3 totaled  2 per cent. Mastectomy for ipsilateral breast tumor recurrence after radiation therapy and lumpectomy comprised 11 per cent. Most underwent immediate breast reconstruction (89%). Reconstructive techniques included two-stage implant (58%), transverse rectus abdominus musculocutaneous (TRAM)  flap (10%), latissimus dorsi musculocutaneous flap with implant (2%), or deep inferior epigastric perforator flap (1%). Complications included a 12 per cent infection rate, removal of two expanders resulting from exposure, one TRAM failure, and one TRAM required débriding. Four patients  undergoing mastectomy with tissue expander had radiation resulting in one expander being removed. One local skin recurrence was treated with removal of implant and skin resection. Two patients have died from metastatic disease. Age should not be a contraindication for breast reconstruction  in elderly women.
authors.affiliation: Department of Surgical Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA. mmcnatt@wfubmc.edu
authors.forename: Marissa
authors.initials: M
authors.lastname: Howard-McNatt
authors.forename: Clay
authors.initials: C
authors.lastname: Forsberg
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.forename: Anthony
authors.initials: A
authors.lastname: DeFranzo
authors.forename: Malcolm
authors.initials: M
authors.lastname: Marks
authors.forename: Lisa
authors.initials: L
authors.lastname: David
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D017060:Patient Satisfaction; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013524:Surgical Flaps; D015625:Tissue Expansion Devices; D016896:Treatment Outcome