title: Patterns and outcomes of breast reconstruction in older women - A systematic review of the literature.
abstract: OBJECTIVE
  Older age is associated with lower rates of breast reconstruction (BR) for women requiring mastectomy. The purpose was to assess the available evidence on uptake, outcome and quality of life (QoL) after BR in older women.
  
  
  METHODS
  A systematic literature review was performed via Medline, Embase and Cochrane databases using the search terms breast reconstruction, breast cancer, and mastectomy. Eligible studies reported rates of BR, rates of different reconstructive techniques, complication rates, and/or patient reported outcome measures (PROMs) of BR in women aged 60 years or older undergoing mastectomy for ductal carcinoma in situ or invasive carcinoma.
  
  
  RESULTS
  A total of 42 eligible studies were included, with 32 of these reporting BR rates, 10 reporting rates of different reconstructive techniques, 10 reporting rates of complications, and four reporting PROMs. The studies reported 24,746 cases of BR in 407,570 mastectomy patients aged 60 years or older from 1987 to 2012. Implant based BR was more common than autologous techniques. Mostly, complication rates were not higher in older women, and QoL outcomes were similar to younger women.
  
  
  CONCLUSIONS
  This review confirms that BR rates are lower in older women despite recent studies demonstrating its efficacy. The perception among some surgeons and women requiring mastectomy that the potential risks of BR in older women outweigh the benefits needs to be revisited. Education of consumers and surgeons along with public advocacy for offering BR to all clinically eligible women are the most promising means of changing practice.
authors.affiliation: Breast and Surgical Oncology, The Poche Centre, 40 Rocklands Rd, North Sydney, New South Wales, Australia.
authors.forename: D D
authors.initials: DD
authors.lastname: Oh
authors.affiliation: Breast and Surgical Oncology, The Poche Centre, 40 Rocklands Rd, North Sydney, New South Wales, Australia; Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Flitcroft
authors.affiliation: Breast and Surgical Oncology, The Poche Centre, 40 Rocklands Rd, North Sydney, New South Wales, Australia; Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: M E
authors.initials: ME
authors.lastname: Brennan
authors.affiliation: Breast and Surgical Oncology, The Poche Centre, 40 Rocklands Rd, North Sydney, New South Wales, Australia; Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia. Electronic address: andrew.spillane@sydney.edu.au.
authors.forename: A J
authors.initials: AJ
authors.lastname: Spillane
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011788:Quality of Life
keywords: Breast cancer; Breast reconstruction; Complications; Elderly; Mastectomy; Outcomes