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J Reconstr Microsurg
DOI: 10.1055/s-0044-1787728
Original Article

Increased Patient Age as a Risk Factor Following Free Flap Reconstruction after Breast Cancer: A Single Institutional Review of 2,598 Cases

Stephanie E. Honig   *
1   Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
2   Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
,
Theodore E. Habarth-Morales   *
1   Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
3   Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Harrison D. Davis
1   Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
4   Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
,
Ellen F. Niu
1   Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
5   Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
,
Chris Amro
1   Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
6   Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
,
Robyn B. Broach
1   Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
,
Joseph M. Serletti
1   Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
,
Saïd C. Azoury
1   Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
7   Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract

Background Autologous breast reconstruction (ABR) after mastectomy is increasing due to benefits over implant-based reconstruction. However, free flap reconstruction is not universally offered to patients of advanced age due to perceived increased perioperative risk.

Methods Patients undergoing free flap breast reconstruction at our institution from 2005 to 2018 were included. Risk-adjusted logistic regression models were fit while controlling for demographic and comorbid characteristics to determine the association of age with the probability of venous thromboembolism (VTE), delayed healing, skin necrosis, surgical site infection (SSI), seroma, hematoma, hernia, and flap loss. Linear predictions from risk-adjusted logistic regression models were used to create spline curves and determine the risk of outcomes associated with age.

Results A cohort of 2,598 patients underwent free flap breast reconstruction in the period examined. The median age was 51 with approximately 9% of patients being 65 or older. Increased age was associated with a greater risk of delayed healing, skin necrosis, and hematoma after surgery. There was no increased risk of medical complications such as VTE or complications such as flap loss, seroma, or SSI.

Conclusion A set age cutoff for patients undergoing free flap breast reconstruction does not appear warranted. There is no difference in major surgical complications such as flap loss with increasing age. However, older age does predispose patients to specific wound complications such as hematoma, skin necrosis, and delayed wound healing, which should guide preoperative counseling. Further, medical complications do not increase with advanced age. Overall, however, the safety of ABR in older patients appears uncompromised.

Keywords

age - free flap - breast reconstruction

* These authors contributed equally to this work.




Publication History

Received: 28 December 2023

Accepted: 05 May 2024

Article published online:
12 June 2024

© 2024. Thieme. All rights reserved.

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