Does age predict perceptions of recovery and long-term chest and upper body morbidity after postmastectomy breast reconstruction?

Abstract

23 Background: Despite evidence that postmastectomy breast reconstruction (PMBR) yields important quality of life benefits, older women (≥ 65 years) rarely receive it. While the perception is that PMBR may result in greater physical morbidity in older women, the additive effects of age and PMBR on physical morbidity have not been studied. This study sought to assess long-term chest and upper body morbidity in older women who receive PMBR. Methods: Women with AJCC stage 0 to III breast cancer who underwent a mastectomy ± PMBR in 2006 to 2011 were surveyed; physical well-being was assessed using the BREAST-Q. Patients were grouped into (3) cohorts: younger (< 65 years) women who underwent PMBR, older women who underwent PMBR, and older women who underwent mastectomy alone. The groups were propensity matched (1:1) to control for differences. Data were analyzed using chi-square and t-tests. Results: 74 younger PMBR, 60 older PMBR, and 88 older unreconstructed mastectomy patients returned surveys (75.3% response rate). The median time from mastectomy to survey was 4.2 years. Younger women were more likely to undergo bilateral mastectomy than older women (54.3% vs. 28.4%, p < 0.001). 63.5% of women underwent implant-only reconstruction and 36.5% underwent autologous reconstruction; there were no significant differences in reconstruction type between age groups. Neither bilateral surgery nor reconstruction type affected BREAST-Q physical well-being scores. Among older women, PMBR was associated with lower mean physical well-being scores than mastectomy alone (79.4 vs. 87.4, p = 0.017, Cohen’s d = 0.56). However, there was no difference in physical well-being scores between older and younger PMBR patients (79.4 vs. 78.5, p = 0.614). Older PMBR patients perceived recovery from surgery as difficult more often than older unreconstructed patients (46% vs. 33%, p = 0.013), but less often than younger PMBR patients (46% vs. 61%, p = 0.036). Conclusions: Older women who undergo PMBR have more long-term chest and upper body morbidity than those who do not have PMBR. However, their morbidity from PMBR and perception of recovery from surgery is comparable to that of younger women. Older women should be counseled that while PMBR is associated with more long-term chest and upper body morbidity, this outcome is independent of age.