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Fancellu A, Deiana G, Sanna V, Rubino C, Cossu A, Cottu P, Giuliani G, Sant L, Norcia G, Porcu A. Rising age-specific rates of immediate breast reconstruction after mastectomy: Report from an Italian Breast Unit. J Surg Oncol 2023; 128:1227-1234. [PMID: 37592864 DOI: 10.1002/jso.27420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Immediate breast reconstruction (IBR) represents a fundamental part in the management of patients receiving mastectomy. In recent years, there has been an increasing trend in the use of IBR in all age groups. The study aims were to evaluate the age-specific trend of IBR, and to discuss its effects in work organization at an Italian Breast Unit. METHODS We searched for women diagnosed with breast cancer between 2010 and 2019, focusing on IBR rates in patients who received mastectomy. Age-specific trends were assessed using the Cochrane-Armitage test. Differences in operative times and hospital stay between women undergoing mastectomy + IBR (Ma + IBR) or mastectomy alone (Ma) were evaluated by Student's t test or χ2 test. RESULTS Among 1915 patients, 62.4% underwent breast conserving surgery (BCS), and 37.6% mastectomy. Overall, rates of Ma + IBR increased from 32% in 2010 to 58% in 2019 (p < 0.001). Although rates of IBR rose in all age groups, the trend was significantly increased among patients aged 50-59 (p < 0.001), 60-69 (p < 0.0001), and 70-79 (p < 0.05). CONCLUSIONS Rates of Ma + IBR have increased over years, especially among older women. Ma + IBR resulted in longer operative times and hospital stay than Ma alone. These findings imply that, in the near future, resources should be implemented to improve and strengthen the surgical activity of Breast Units, to support the increasing use of IBR in women of all age groups.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Giulia Deiana
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Valeria Sanna
- AOU Sassari, Department of Oncohematology, Unit of Medical Oncology, Sassari, Italy
| | - Corrado Rubino
- Department of Medicine, Surgery and Pharmacy, Unit of Plastic Surgery, University of Sassari, Sassari, Italy
| | - Antonio Cossu
- Department of Medicine, Surgery and Pharmacy, Unit of Pathology, University of Sassari, Sassari, Italy
| | - Pietrina Cottu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Giuliana Giuliani
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Lisa Sant
- Faculty of Medicine and Surgery, University of Sassari Medical School, Sassari, Italy
| | - Giuseppe Norcia
- Faculty of Medicine and Surgery, University of Sassari Medical School, Sassari, Italy
| | - Alberto Porcu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
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Heikkinen J, Bonde C, Oranges CM, Toia F, di Summa PG, Giordano S. Efficacy of breast reconstruction in elderly women (>60 years) using deep inferior epigastric perforator flaps: A comparative study. J Plast Reconstr Aesthet Surg 2023; 84:266-272. [PMID: 37356302 DOI: 10.1016/j.bjps.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/15/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The indications for microsurgical breast reconstruction remain debated, particularly concerning the safety of deep inferior epigastric perforator (DIEP) flaps in elderly women. Free tissue transfer still carries a risk of perioperative morbidity and mortality in elderly patients. We conducted this comparative study to clarify this issue. METHODS This retrospective cohort study included all unilateral DIEP breast reconstructions performed at a single institution. Patients were divided into two groups based on age: an elderly (60 years or older) and a non-elderly cohort (younger than 60 years). Demographic and comorbidity data were secondary predictor variables. The primary outcomes were complete flap loss, partial flap loss, and the need for flap re-exploration. The secondary outcomes included surgical site occurrences, such as wound healing-related complications, seroma, and others. RESULTS We included 214 flaps, 177 in the non-elderly and 37 in the elderly cohort. Elderly women had slightly higher comorbidity rates than those of non-elderly women, although these differences were not statistically significant. BMI was significantly lower in elderly women than in non-elderly women. The incidence of total or partial flap loss did not differ significantly between the two cohorts (2.7% vs 1.1%, p = 0.459% and 0.0% vs 5.1%, p = 0.161), nor did the flap re-exploration (8.1% vs 10.1%, p = 0.937). Similarly, postoperative complication rates did not differ significantly between the two groups (45.9% vs 61.8%, p = 0.074). On logistic regression, being elderly was not a risk factor for complete flap loss, nor for any complications. The overall success rate for the non-elderly cohort was 98.7%, whereas that for the elderly cohort was 97.3%. CONCLUSIONS Microsurgical breast reconstruction using DIEP is safe in elderly patients, as it achieves outcomes and complications rates comparable to those observed in a younger population. Patients should not be denied DIEP flaps because of their age alone.
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Affiliation(s)
- Jarna Heikkinen
- Department of General and Plastic Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Christian Bonde
- Department of Plastic Surgery, Breast Surgery, and Burns, Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Carlo M Oranges
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesca Toia
- Department of General and Plastic Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; Department of Plastic Surgery, Breast Surgery, and Burns, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pietro G di Summa
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Salvatore Giordano
- Department of General and Plastic Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
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Chang-Azancot L, Abizanda P, Gijón M, Kenig N, Campello M, Juez J, Talaya A, Gómez-Bajo G, Montón J, Sánchez-Bayona R. Age and Breast Reconstruction. Aesthetic Plast Surg 2023; 47:63-72. [PMID: 35927500 DOI: 10.1007/s00266-022-03024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breast reconstruction is frequently offered to cancer patients who undergo mastectomy. Older women tend to have lower rates of reconstruction mostly due to an age-based discretion. We aimed to assess the safety of this surgery in this population. METHODS We conducted a single-center retrospective analysis of patients who underwent breast reconstruction following mastectomy between 2015 and 2020 at "Complejo Hospitalario Universitario de Albacete." Patients were classified according to age when the reconstruction process began (group A: < 65 years-group B: > 65 years). Differences in demographics and clinical data were analyzed using Student's t test and Chi-square test. Multivariable logistic regression models were used to estimate odds ratio (OR) and confidence intervals (CIs) for surgical complications according to age group. Propensity-score matching was used as a sensitivity analysis to test consistency among results. RESULTS We included 304 women (266: group A-38: group B). Complete reconstruction was achieved in 48.1% of patients in group A vs 10.5% in group B (P < 0.001). After adjusting for potential confounders, age was not associated with an increased risk of surgical complications, neither overall (OR 0.88, 95%CI 0.40-1.95), early (OR 1.35, 95%CI 0.58-3.13) nor late (OR 1.05, 95%CI 0.40-2.81). Radiotherapy and smoking history were significant predictors for complications in every setting. CONCLUSIONS In our cohort, age at breast reconstruction is not associated with a higher risk of surgical complications, in contrast to radiotherapy and smoking history. Therefore, age should not be a limiting factor when considering breast reconstruction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Luis Chang-Azancot
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain.
| | - Pedro Abizanda
- Geriatrics Department, Complejo Hospitalario Universitario of Albacete, Albacete, Spain.,CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
| | - María Gijón
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Nitzan Kenig
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Manuel Campello
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Jessica Juez
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Antonio Talaya
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Gregorio Gómez-Bajo
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
| | - Javier Montón
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain.,Anatomy and Embryology Unit, Faculty of Medicine, University of Castilla-La Mancha (UCLM), Albacete, Spain
| | - Rodrigo Sánchez-Bayona
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, 28041, Madrid, Spain
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