by Torabi, Radbeh;
Stalder, Mark W.; Tessler, Oren; Bartow, Matthew J.; Lam, Jonathan; Patterson,
Charles; Wise, M. Whitten; Dupin, Charles L.; St. Hilaire, Hugo
Background: Breast
cancer is primarily a diagnosis of older women. Many patients seeking breast
reconstruction are elderly women (aged 65 years or older). However, many surgeons
anecdotally believe that surgery in elderly patients is inherently dangerous,
or at least prone to more complications.
Methods: The authors conducted a
retrospective cohort study composed of chart review of all deep inferior
epigastric perforator flap breast reconstruction patients at a single
institution divided into an elderly cohort (65 years or older) and a nonelderly
cohort (younger than 65 years). Cohort was the primary predictor variable.
Demographic and comorbidity data were secondary predictor variables. Primary
outcomes were complete flap loss, partial flap loss, or need for flap
reexploration. Secondary outcomes such as wound healing problems, seroma, and
others were also assessed.
Results: There were 285 flaps in the nonelderly
cohort and 54 flaps in the elderly cohort. The elderly cohort had higher rates
of diabetes, hypertension, and hyperlipidemia. Chi-square analysis showed no
significant differences in primary outcomes between the two cohorts. Breast
wound dehiscence was significantly higher in the elderly cohort (p < 0.01).
On logistic regression, being elderly was seen as a significant risk factor for
complete flap loss (OR, 10.92; 95 percent CI, 0.97 to 122.67; p = 0.05). The
overall success rate for the nonelderly cohort was 99.6 percent, whereas the
success rate for the nonelderly cohort was 96.3 percent.
Conclusions: Elderly
women desire breast reconstruction. Free flap breast reconstruction is a viable
and safe procedure in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk,
II.
