title: Autologous Breast Reconstruction in Women Older Than 65 Years Versus Women Younger Than 65 Years: A Multi-Center Analysis.
abstract: BACKGROUND
  Autologous breast reconstruction has been shown to have fewer complications and superior outcomes. In the elderly patient population, a paucity of literature on the subject may render the surgeon reluctant to recommend or perform such a procedure. The objective of this study was to compare complications and satisfaction after abdominally based breast reconstruction in patients older than versus younger than 65 years.
  
  
  METHODS
  A retrospective study was performed with data from 5 North American centers from 2002 to 2012. Patients who underwent autologous reconstruction were identified retrospectively, and chart review was performed. The BREAST-Q questionnaire was sent to these patients via mail. Patient variables, operative outcomes and BREASTQ results were analyzed. The Pearson χ² and analysis of variance tests were used. Given the number of analyses, a more conservative α of 0.01 was used for each comparison.
  
  
  RESULTS
  A total of 1809 patients were included with 1751 patients younger than 65 years and 58 patients aged 65 years or older. Analysis of postoperative complications showed no significant differences between the age groups, though there was a trend toward higher seroma development (17.2% vs 8.1%; P = 0.013) and infection (19.0% vs 10.0%; P = 0.028) in the older group with statistical significance set at P less than 0.01 to account for multiple comparisons. A total of 1809 BREAST-Q surveys were sent with a response rate of 52.5%. Patient satisfaction results were equally high between the 2 age groups.
  
  
  CONCLUSIONS
  This is the largest study to compare patients undergoing autologous breast reconstruction older than and younger than 65 years within the same cohort. Women older than 65 years represent a minority and constituted only 3% of patients in this multicenter 10-year review. We have shown that with careful patient selection, abdominally based autologous reconstruction should be considered in the elderly patient population because it is well tolerated and achieves high patient satisfaction.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, †Department of Psychology, University of British Columbia, Vancouver, BC; ‡University Health Network Division of Plastic Surgery, University of Toronto, Toronto, ON, Canada; §New York Medical Center, New York University, New York, NY; and ∥Section of Plastic Surgery, Dartmouth Medical School, Lebanon, NH.
authors.forename: Diana
authors.initials: D
authors.lastname: Song
authors.forename: Karen
authors.initials: K
authors.lastname: Slater
authors.forename: Michael
authors.initials: M
authors.lastname: Papsdorf
authors.forename: Nancy
authors.initials: N
authors.lastname: Van Laeken
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
authors.forename: Alexes
authors.initials: A
authors.lastname: Hazen
authors.forename: Dale
authors.initials: D
authors.lastname: Vidal
authors.forename: Sheina A
authors.initials: SA
authors.lastname: Macadam
mesh_terms: D000368:Aged; D019928:Breast Implantation / Q000379:methods / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000706:statistics & numerical data*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D018570:Risk Assessment; D014182:Transplantation, Autologous; D014481:United States