American Association of Plastic Surgeons

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Age Impacts Clinical And Patient Reported Outcomes Following Post Mastectomy Breast Reconstruction
Minji Kim, BS, Barkat Ali, MD, Kevin Zhang, BA, Perri Vingan, BS, Lillian Boe, PhD, Catherine L. Ly, MD, Robert J. Allen, Jr., MD, Evan Matros, MD, Peter G. Cordeiro, MD, Babak Mehrara, MD, Jonas A. Nelson, MD, MPH;
Memorial Sloan Kettering, New York City, NY, USA

Purpose: The incremental impact of increasing age on complications and patient reported outcomes (PROs) after postmastectomy breast reconstruction (PMBR) remains unknown. The purpose of this study is to understand the impact of age on complications and PROs using BREAST-Q longitudinally 5-years after PMBR.Methods: A retrospective study patients who underwent autologous or implant-based breast reconstruction between 2017 and 2022 were included. Outcome measures of interest were postoperative complications and BREAST-Q scores from preoperative, 6-months, and 1-5 years postoperatively.Results: 5,352 PMBR patients were included. Multivariable logistic regression models showed that older age was significantly associated with increased rates of necrosis (OR=1.02 [95%CI: 1.00,1.03], p=0.006), seroma (OR=1.02 [1.01,1.03], p=0.007), infection (OR=1.01 [1.00,1.02], p=0.035), and hematoma (OR=1.01 [1.00,1.03], p=0.048). Stated differently, with every 10 years, the rates of necrosis or seroma increase by 20% while infection and hematoma increase by 10%. Older age was negatively correlated with Physical Well-being of the Chest (=-0.05 [95% CI: -0.09,-0.01], p=0.01) and Satisfaction with Breasts (=-0.07 [-0.12,-0.02], p<0.01), positively correlated with Psychosocial Well-being (=0.13 [0.08,0.18]; p<0.01), and not correlated with Sexual Well-being (=-0.05 [-0.10,0.00]; p=0.07).Conclusion: This 5-year longitudinal analysis of surgical outcomes and PROs suggests that complication rates increase with age and older age has a negative correlation with Physical Well-being of the Chest and Satisfaction with Breasts but a positive correlation with Psychosocial Well-being, regardless of the reconstructive type. Overall, age should be considered alongside other important factors, such as frailty, when determining whether a patient is a suitable candidate for PMBR.
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