Mastectomy and immediate breast reconstruction in the elderly: Trends and outcomes

Background: Immediate breast reconstruction after mastectomy may confer more complication rates in the elderly. Therefore, granular analysis of postmastectomy complications in women aged ≥65 years may help formulate clinical guidelines to improve patient selection and outcomes. Methods: We identified patients undergoing mastectomy with or without immediate reconstruction from our breast surgery database (2014–2018). Complications requiring treatment were compared between patients aged ≥65 and <65 years. Results: A total of 1,721 mastectomies were performed in 1,698 patients; 85.8% had a 30-day follow-up. Of these patients, 968 (65.6%) had immediate breast reconstruction, of whom 95 (9.8%) were aged ≥65 years. Among patients aged ≥65 years, 27.6% underwent mastectomy with immediate breast reconstruction compared with 77.1% of women aged <65 years (P <.001). Overall complication rates were not greater for older compared with younger mastectomy patients but were for older versus younger patients who had mastectomy with immediate breast reconstruction (12.6% vs 6.8%; P =.04). Hematoma requiring reoperation was more frequent in patients aged ≥65 years (5.3% vs 0.9%; P =.006). Necrosis (5.3% vs 2.6%; P =.18) and 30-day unplanned readmissions (7.4% vs 4.0%; P =.18) were not greater. Conclusion: Despite low overall postoperative complication rates, we found some clinically relevant differences between older and younger patients after mastectomy with immediate breast reconstruction. Additional investigation of contributing factors may help further refine patient selection. In the interim, elderly patients should be counseled on their somewhat greater risk of postoperative complications to facilitate shared decision making.