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Age does not influence breast reconstruction complications

A microscopic image of a poorly differentiated, grade 3, infiltrating (invasive) ductal carcinoma.

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Despite the concerns of the older women were not more complications in the breast reconstruction procedures than younger women, a new U.S. study suggests.

In fact, the researchers found, women over the age of 60 had better sexual, physical, and psychosocial well-being than younger women following a type of reconstruction procedure that uses a woman’s own tissue to rebuild the breast.

“There is still a persistent prejudice among both patients and doctors that once you get to a certain age, the reconstruction is more risky,” said senior study author Edwin Wilkins, a professor in plastic surgery at the University of Michigan in Ann Arbor. “Anecdotally, in my own practice, I have not found that to be the case.”

“We can’t make patients look like nothing happened, but we can, in most cases, a result that improves their self-esteem and contributes to the quality of life,” Wilkins said. “These benefits are not limited to certain age group.”

Approximately 250,000 AMERICAN women will be diagnosed with breast cancer in 2016, and 40 percent of them will be older women, according to the National Cancer Institute. The median age of breast cancer diagnosis is now 62.

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If the survival rates improve, more women are living longer after breast cancer treatment and more are looking for mastectomies and breast reconstruction, the authors of the study write in the Journal of the American College of Surgeons. Despite this trend, women over 60 are less likely to have reconstruction.

The researchers looked at two-year complication rates such as hospital readmission and removal of the implant, the patient-reported outcomes such as breast satisfaction and sexual well-being in the 1,531 patients who have a reconstruction at the 11 institutions in the united states and Canada between 2012 and 2014.

The patients were divided into three age groups: younger than 45 years, 45 to 60 and older than 60 years.

Older women have more sexual well-being scores than the middle aged and young women with both the implant and the so-called autologous procedures that make use of the woman’s own tissue instead of an implant. Although older women are also better psychosocial and physical well-being with autologous procedures, there was no difference between the age groups in the categories with the implants procedures.

“This study is really important, because there are more women with mastectomies, and the decision on reconstruction is becoming more common,” said Clara Lee of the Ohio State University in Columbus, who was not involved in the study. “Plastic surgeons have said, ‘research suggests this,” but now they can have more confidence in counseling patients.”

A few previous studies have assessed post-mastectomy breast reconstruction in older women, in particular, with the patient-related factors such as satisfaction, Lee told Reuters Health. In addition, most studies looking at 30 days after the reconstruction, instead of two years.

“This study looks at the results in a rigorous way and has a longer follow-up than almost every study in this area,” Lee noted. “Women do not just care what happens to them in 30 days. They provide for the future.”

The complication rates, which ranged from 15 to 30 percent, are “not to be sneezed at,” Lee added. These rates were generally higher in women undergoing autologous reconstruction over implant procedures, but two years of reconstruction failure rates were lower with autologous procedures than with implants.

The differences between women who had different types of reconstruction are some of the study’s limitations. For example, the younger cohort had more bilateral mastectomies than the other two groups, said Emily Bellavance, University of Maryland Medical Center in Baltimore, who was not involved in the study.

“We know that the complication rates of bilateral mastectomy with reconstruction compared to unilateral construction can be two to three times higher,” she told Reuters Health by e-mail.

Ultimately, breast cancer patients need as much information as possible about the complications, the results and the satisfaction of the rates, Wilkins said.

“Women choose what works best for them, and we as practitioners need to respect that,” he said. “Breast cancer patients are smart, and we should give them all the information they need to make the best choices based on their own preferences and values.”

 

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