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Age Alone Doesn’t Increase Breast Reconstruction Complications

Breast reconstruction using a “free flap” technique is a safe procedure with a high success rate in older women who opt for reconstruction after mastectomy, reports a study in the December issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Although the risk of some complications is higher, free-flap reconstruction has “generally good outcomes” in women aged 65 or older, according to the report by ASPS Member Surgeon Oren Tessler, MD and colleagues at Louisiana State University Health Sciences Center, New Orleans.

Patient’s health, not just age, affects results of DIEP flap reconstruction

The researchers analyzed their experience with the DIEP flap for breast reconstruction after mastectomy, comparing the outcomes in older versus younger women. Free flaps are an autologous reconstructive procedure, meaning that they use the patient’s own tissues rather than implants. The DIEP flap uses tissue from the patient’s abdomen.

The study included DIEP flap reconstruction of 339 breasts in 208 patients. Complications and risk factors were compared in a group of older women (average age of 67 years, 54 flaps) versus younger women (average age of 49 years, 285 flaps). The older women had substantially higher rates of medical risk factors, including diabetes, high blood pressure and high cholesterol.

The primary outcome – complete or partial loss of the DIEP flap or the need for further flap surgery – was not significantly different between the older and younger groups. Dehiscence, a type of wound-healing complication, was more common in the older group; nearly 26% compared with 8% in the younger group. Complications related to the flap donor site in the abdomen were similar between age groups.

After adjustment for other factors — including the higher rate of medical risks in older women — age was a significant risk factor for complete flap loss as well as wound dehiscence. However, the absolute risk of complete flap loss was very low with only three cases in a total of 339 DIEP flaps. Dr. Tessler comments, “The overall success rate in our older DIEP flap cases was 96.3%, only marginally lower than the 99.6% rate in our younger cases.”

Some increased risks after breast reconstruction in women 65 or older appear at least partly related to the higher rates of medical risk factors among older women. The findings reinforce the importance of assessing the individual patient’s health status, not just age alone, in determining the risks of breast reconstruction.

Source: American Society of Plastic Surgeons

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