Older women should not rule out breast reconstruction

Age should not be a contraindication for breast reconstruction in elderly women, data from a retrospective chart review indicate.

Noting that breast reconstruction is underused in women older than 60 years and that there is a lack of information examining breast cancer reconstruction in the elderly, Marissa Howard-McNatt, MD, of Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, and colleagues investigated the matter. They reviewed information from 89 women aged 60 to 74 years (mean, 65 years) who had undergone mastectomy and reconstructive surgery between January 1998 and June 2008. The majority of patients had stage 1 or stage 2 disease.

Most of the women (89%) immediately underwent some form of breast reconstruction, including 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%).

Howard-McNatt's team found breast construction to be safe, feasible, and well-tolerated in these women. Complications included a 12% infection rate, removal of two expanders resulting from exposure, one TRAM failure, and one TRAM that required debridement. Four of the women undergoing mastectomy with tissue expander had radiation that resulted in removal of one expander. One local skin recurrence was treated with removal of the implant and skin resection. Two of the patients have died from metastatic disease.

In a statement announcing the findings, which were reported in The American Surgeon (2011;77[12]:1640-1643[4]), Howard-McNatt acknowledged that women with comorbidities such as coronary artery disease, diabetes, and respiratory illnesses may not be suitable candidates for mastectomy. Generally, however, “The safety of reconstruction, as well as increased life expectancy and healthier lifestyles, makes breast reconstruction desirable at any age,” noted Howard-McNatt.

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