title: Breast Reconstruction in Elderly Patients: Risk Factors, Clinical Outcomes, and Aesthetic Results.
abstract: BackgroundCorrelation among age, clinical, and aesthetic outcomes in implant-based and autologous breast reconstructions was investigated.MethodsBetween 2004 and 2014, a retrospective study was performed on patients who underwent reconstruction following mastectomy. Patients were divided in group A (< 50 years), group B (≥ 50-59 years), group C (≥ 60-69 years), and group D (≥ 70 years). Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and length of stay were assessed using chi-square and Kruskal-WallisHanalysis consideringp≤ 0.05 as significant. Pre- and postoperative photographs were taken to grade aesthetic results by patients and blinded plastic surgery team.ResultsA total of 993 patients underwent 1,251 breast reconstructions, of which 356 (28.5%) were implant-based, 402 (32.1%) pedicled-flap, 445 (35.6%) free-flap, and 48 (3.8%) fat-graft reconstructions. There were 316 (25.2%) complications, of which 124 (34.8%) in implant-based, 74 (18.4%) in pedicled-flap, 111 (24.9%) in free-flap, and 2 (4.2%) in fat-graft reconstructions. Mean length of stay was 5.4 days without significant difference between age groups (p= 0.357). The incidence of overall complications was not significantly related to age, ASA class, smoking history, and previous radiotherapy. Body mass index was a significant predictor (p= 0.001), but odds ratio (OR: 1.2) demonstrated only a minimal increase in risk. Implant-based reconstruction was associated with a higher risk for complications compared with the other ones (OR: 2.5,p= 0.001). Patient and surgeon aesthetic surveys demonstrated an overall positive opinion in all age groups for each reconstructive option.ConclusionAdvanced age should not be considered a risk factor for breast reconstruction, while implant-based technique was associated with a higher risk for complications compared with autologous that may provide older women with greater benefits.
authors.affiliation: Department of Plastic Surgery, "Sapienza" University of Rome, Sant'Andrea Hospital, Roma, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Laporta
authors.affiliation: Department of Plastic Surgery, "Sapienza" University of Rome, Sant'Andrea Hospital, Roma, Italy.
authors.forename: Michail
authors.initials: M
authors.lastname: Sorotos
authors.affiliation: Department of Plastic Surgery, "Sapienza" University of Rome, Sant'Andrea Hospital, Roma, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Longo
authors.affiliation: Department of Plastic Surgery, "Sapienza" University of Rome, Sant'Andrea Hospital, Roma, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Santanelli di Pompeo
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D018427:Breast Implants; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D004954:Esthetics / Q000523:psychology*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome