American Society of Plastic Surgeons
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No Increase in Complications of Breast Reconstruction over Age 65
But Problems with Blood Clots May Be More Common in Older Women, PRS Study Suggests


Older women don't have an increased overall risk of complications from breast reconstruction after mastectomy, reports the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"Older patients should be counseled that their age does not confer an increased risk of complications after implant-based post-mastectomy breast reconstruction," concludes the study by ASPS member surgeon Mark Sisco, MD, of NorthShore University HealthSystem and University of Chicago and colleagues. However, the results do suggest that women aged 65 or older are at increased risk of blood clot-related complications after tissue-based breast reconstruction.

No Difference in Overall Complications by Age...

Using a national surgery database, the researchers identified nearly 41,100 women who had unilateral mastectomy (removal of one breast) between 2005 and 2012. Of these, about 11,800 patients underwent breast reconstruction. Women aged 65 or older were less likely to have breast reconstruction: 10.8 percent, compared to 39.5 percent for younger women.

Compared to mastectomy only, women undergoing breast reconstruction had more complications, including increased hospital days and repeat surgeries. The complication rate after breast reconstruction was 6.8 percent for older women and 5.2 percent for younger women.

The overall risk of complications did not differ significantly between age groups, after adjustment for other factors. The risk remained the same for older and younger women undergoing breast reconstruction using implants.

...But Higher VTE Risk in Older Women after Autologous Reconstruction

However, after autologous reconstruction—creation of a new breast using the patient's own tissues—the risk of blood clot-related complications called venous thromboembolism (VTE) was significantly higher for older women. VTE is a common and serious condition in which blood clots form in the leg or other veins (deep vein thrombosis) or lung (pulmonary embolism).

On adjusted analysis, VTE risk was nearly four times higher in women aged 65 or older, and more than six times higher for those aged 70 to 75. The overall rate of VTE after autologous reconstruction was just under one percent. Other types of complications were similar between age groups.

Breast reconstruction "is an important option for women undergoing mastectomy and may improve patient self-esteem, body image, and quality of life," the researchers write. Older women are much less likely to undergo breast reconstruction—partly because of a perceived increase in surgical risk.

While older women may have reasons for not undergoing breast reconstruction, there's little evidence on how age affects complication risk. "As such, it is impossible for older women to make informed decisions about the risks and benefits of post-mastectomy breast reconstruction that take into account their age," according to Dr Sisco and colleagues.

The new study shows a similar overall complication rate for older versus younger women undergoing breast reconstruction. "Older women considering implant-based reconstruction should be assured that their age is not a factor in determining the risk of complications," the researchers write.

"However, they should be counseled that their age may confer an increased risk of VTE," Dr Sisco and coauthors add. They suggest that older women may need special attention to preventing VTE after autologous breast reconstruction—possibly including longer use of blood-thinning medications.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 70 years, Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2019 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

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