WOMEN'S HEALTH
November 23, 2016

Older Women and Breast Reconstruction

Women over 60 benefit from breast reconstruction just as much as younger women do.

Women undergoing a mastectomy for breast cancer face an emotionally challenging decision: whether or not to have reconstruction of the affected breast. Few studies have looked at the outcomes of reconstruction in older women, although more than 40% of women diagnosed with breast cancer are 62 years of age or older.

But older women benefit just as much as younger women from breast reconstruction following mastectomy, recently published study findings suggest. And older women do not have a significantly greater rate of complications from the procedure compared to younger women.

If you are over 60, you may still be a good candidate for reconstruction.

This data defy conventional wisdom. Among surgeons and perhaps even some patients, there is a general view that reconstruction may not be as safe or effective an option in women over 60, Edwin Wilkins, principal author on the study, told TheDoctor. The thinking is that the risk may outweigh benefits.

This idea may be more patient-driven than surgeon-driven, says Wilkins. Patients, especially those over 55 or 60, often believe reconstruction may not be as safe as it would have been earlier in their lives. Wilkins finds that older patients don’t want reconstruction any less, but they are more risk averse.

“What we are trying to do with this study is empower women with the information they need so they can choose what is right for them,” says Wilkins. So if you are over 60, you may still be a good candidate for reconstruction.

The current study was fairly novel in its scope. It started before the women had surgery and followed them over a two-year period after reconstruction. The investigators analyzed data from 1,531 women enrolled in the Mastectomy Reconstruction Outcomes Consortium (MROC) study involving 11 large cancer centers and hospitals, as well as 57 providers.

Past studies had looked back at the previous 10 years, identified women who had reconstruction and studied them, Wilkins, a professor of surgery at the University of Michigan Health System in Ann Arbor, explained. “Where a patient is before surgery has a large effect on where she’ll be two years later.”

Wilkins and his team divided the women into three groups based on age: those under 45 years old, those 45 to 60 years old and women over 60. Age was not a significant predictor of physical complications. 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.

Age had a modest effect on women who had their breast reconstructed with a surgical implant, with older women being slightly less satisfied. But women over 60 who had their breast reconstructed using their own (autologous) tissue reported psychosocial and physical well being equal to that of younger women.

“Be as well informed as you can about your options,” advises Wilkins. Read up, educate yourself, talk to your doctor, weigh the pros and cons of various options and then, with your doctor’s help, choose what will work best for you. That's what will give you the benefits you want and need.

The study is published in the Journal of the American College of Surgeons.

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