Effect of Patient Age on Outcomes in Breast Reconstruction
The most comprehensive study of its kind to date found that older women enjoy the same benefits from breast reconstruction following mastectomy for breast cancer as younger women, without a significant increase in the risk for complications. As with patients across all age groups, the benefits of breast reconstruction must be weighed against the risks. However, these study results showed that the procedure was successful in the vast majority of cases and that age alone should not disqualify a woman from undergoing a reconstruction procedure.
The study, published by Santosa et al in the Journal of the American College of Surgeons, evaluated clinical and patient-reported outcomes 2 years after women underwent mastectomy and breast reconstruction for breast cancer. The study included 1,531 women who had the surgery at one of 11 institutions in the United States and Canada that participated in the Mastectomy Reconstruction Outcomes Consortium (MROC) study.
Of the nearly 250,000 women to be diagnosed with breast cancer in 2016, 40% will be 62 years of age or older. Although the use of mastectomy in the treatment of breast cancer has increased over the last 10 years, older women are less likely to have the procedure than younger ones.
Previous studies that examined the use of breast reconstruction in women of different age groups have been hampered by study design or size. Studies have been small and confined to patients treated in a single clinical institution, so their findings do not apply to other patient populations that receive treatment in other clinical settings. Many studies have not included patient-reported outcomes that determine satisfaction and quality of life following surgery, or they assessed complication rates only in the period immediately following surgery, according to principal author Edwin G. Wilkins, MD, Professor of Surgery in the Section of Plastic Surgery at the University of Michigan Health System.
MROC Study Findings
MROC is a prospective, long-term, National Cancer Institute–funded study focused on outcomes associated with various types of breast reconstruction in different patient populations. MROC recruited patients between February 2012 and July 2016. It was not only large in size and multi-institutional; it assessed outcomes over a long term. It also was prospective in nature.
“Most previous studies provided just a snapshot in time. They looked retrospectively at the previous 10 years, identified patients who had breast reconstruction, and then studied them. This study started before the patients had reconstruction and followed them for 2 years afterward. It essentially studied all patients over the same interval. It provided a baseline measurement of body image, quality of life, and overall health, because where a patient is before surgery has a large effect on where she ends up 2 years later,” Dr. Wilkins explained.
The study categorized patients by age group: 494 were younger (< 45 years old); 803 were middle-aged (45–60 years old); and 234 were older (> 60 years old). The investigators determined overall rates for any type of complication as well as any major complication that required hospital admission or surgical exploration.
In addition, the investigators compiled information about patient-reported outcomes using the BREAST-Q Reconstructive Module. BREAST-Q is a validated data-gathering instrument that has been widely used to assess patient satisfaction and patients' perceptions of psychosocial, physical, and sexual well-being following breast reconstruction.
Complication rates varied by surgical procedure (ie, insertion of a surgical implant vs use of a patient's own tissue). Among women who received a surgical implant, the rate for any complication was 22% in the younger age group, 27% in the middle-aged group, and 29% in the older group. The rate for a major complication among women who had an autologous procedure was 33% in younger women, 29% in the middle-aged, and 31% in older women.
Only one group of women expressed a slight decline in their satisfaction after breast reconstruction. Older women who had implant surgery had a BREAST-Q satisfaction score of 60.9 preoperatively and a score of 59.2 afterward. All other groups of women were just as satisfied with their breasts after reconstruction as they were before undergoing the procedure. “Breast reconstruction has been described as a ‘reverse mastectomy.’ Given the findings from our study, it's hard to dispute that contention, regardless of age,” Dr. Wilkins said.
“Surgeons and patients may have preconceived notions that breast reconstruction is not as good an option in older women as it is in younger patients. According to findings from this study, reconstruction provided the benefits it was expected to provide for quality of life and body image, and age did not significantly affect complications,” Dr. Wilkins said.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
