An Analysis of Age on Complications and Patient Reported Outcomes after Breast Reconstruction with 5,352 Patients
Minji Kim, Barkat Ali, Perri Vingan, Jonas Nelson, Carrie Stern, Babak Mehrara
Memorial Sloan Kettering, USA
Rates of breast reconstruction is lower among older women due to age-based discretion. This study aims to assess the impact of age on complications and short- and long-term quality of life.
A retrospective analysis of patients who underwent postmastectomy breast reconstruction from 2018 to 2021 and completed any of the BREAST-Q modules was performed. Age was analyzed as a continuous and categorical variable; it was categorized as follows: <40, 40-49, 50-59, 60-69, and 70+. All BREAST-Q domains were collected preoperatively and postoperatively, at 6-months and annually up to 5-years.
5,352 patients were included, of which 835 (16%) were <40 years old, 1,893 (35%) were 40-49, 1,671 (31%) were 50-59, 782 (15%) were 60-69, and 171 (3.2%) were older than 70. A significantly greater proportion of older patients experienced seroma and hematoma than younger patients (p=0.045, p<0.001, respectively).
Median Satisfaction with Breasts score decreased with age at 6-months after surgery (64 vs. 62 vs. 61 vs. 58 vs. 57, respectively, p=0.004). There were no significant differences at other timepoints. Psychosocial Well-being significantly improved with age at 1-, 2-, 3-, and 4-years postoperatively. Linear regression models demonstrated that older age was associated with decreased Physical Well-being of the Chest (β=-0.07, 95% CI: -0.11, -0.04, p<0.001), Sexual Well-being (β=-0.06, 95% CI: -0.11, -0.01, p=0.023), and Satisfaction with Breasts (β=-0.09, 95% CI: -0.14, -0.05, p<0.001). However, age was associated with increased Psychosocial Well-being (β=0.13, 95% CI: 0.09, 0.17, p<0.001).
Older patients may experience seroma and hematoma more frequently than younger patients, with no difference in rates of other complications. Age may have a negative impact on BREAST-Q domains, except for Psychosocial Well-being. Additional interventions may be necessary to optimize older patients' quality of life and younger patients' psychosocial health after breast reconstruction.
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