Age Impacts Clinical and Patient-Reported Outcomes following Postmastectomy Breast Reconstruction

Background: Although the current literature indicates that age should not be a deterring factor in postmastectomy breast reconstruction, the true impact of increasing age on postoperative outcomes remains unknown. The purpose of this study is to understand the impact of age on complications and patient-reported outcomes (PROs) using the BREAST-Q longitudinally 5 years after postmastectomy breast reconstruction. Methods: The authors conducted a retrospective analysis of patients who underwent autologous (ABR) or implant-based reconstruction (IBR). Age was studied as both a categorical and a continuous variable. Outcome measures included complications and BREAST-Q scores preoperatively, at 6 months, and 1 to 5 years postoperatively. Results: A total of 4730 patients were included, of which 1536 (32.5%) underwent ABR and 3194 (67.5%) underwent IBR. Older age was significantly associated with increased risk of developing mastectomy skin flap/nipple necrosis, infection, and seroma. Older age was negatively correlated with Satisfaction with Breasts (beta = -0.06 [95% CI, -0.12 to -0.01]; P = 0.033) and positively correlated with Psychosocial Well-being (beta = 0.14 [95% CI, 0.09 to 0.20]; P < 0.001). Older age was not correlated with Physical Well-being of the Chest (beta = -0.03 [95% CI, 0.08 to 0.02]; P = 0.2) or Sexual Well-being (beta = -0.04 [95% CI, -0.12 to 0.02]; P = 0.2). Subgroup analyses of ABR and IBR patients demonstrated different complications and PRO profiles. Conclusions: The authors' analysis of the impact of age on surgical outcomes and PROs suggests that complication rates increase with age, and older age is negatively correlated with Satisfaction with Breasts but positively correlated with Psychosocial Well-being. Overall, older patients should be informed about the potential associated risks and anticipated PROs. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.