Here in Sarasota, Altiora is updating news on Free Flap Breast Reconstruction after mastectomy. At Altiora, we realize this type of surgery is a troubling issue for all women. And it’s even more so for older women. So, the plastic surgeons here in Sarasota are eager to share an article full of special news and research. And it is just for our older ladies.
Big News for Older Women Who Survive Breast Cancer
The term “free flap breast reconstruction” sounds intimidating. And it comes to you, as a cancer patient, at a tough time of making survival decisions. You know you must have a mastectomy. Then you must deal mentally and emotionally with more surgery in order to restore your wholeness and femininity. We are excited to reveal significant scientific research news. And we dedicate this blog to cancer survivors who face this decision every day.
The Discovery: Age Alone Won’t Hurt Your Success with Free-Flap Breast Reconstruction
First of all, we want you to know that free flap breast reconstruction is safe. This involves using a “free flap” from the patient’s abdomen and is a safe procedure. Older women are enjoying a high rate of success with this surgery. Why don’t older women know this? You see, “Breast cancer is primarily a diagnosis of older women. Many patients seeking breast reconstruction are elderly women (aged 65 years or older).” However, it might be easier to understand if you compare women of today with women of 30 years ago. Just as Americans live longer, the concept of age and “elderly” is changing.
Yet some stigmas remain. Many in the medical profession consider 65 to be “elderly.” In spite of this predisposition in the medical community, we see many 65-year-old women today that live as if 65 is the new 45.
The Stigma of the Elderly Concept
The Journal of Plastic and Reconstructive Surgery has a different viewpoint. “However, many surgeons anecdotally believe that surgery in elderly patients is inherently dangerous, or at least prone to more complications.” Recent studies have proven this to be false. In fact, the research indicates that that free-flap reconstruction has “generally good outcomes” in women aged 65 or older.
Surgeon Oren Tessler, MD, MBA is an ASPS Member. He and colleagues of Louisiana State University Health Sciences Center, New Orleans reported the following. Older women desire breast reconstruction after mastectomy. And they should be offered all reconstruction options available.
Your General Health, Not Just Your Age, Affects Results of DIEP Flap Reconstruction
What is Free Flap Breast Reconstruction? Free flaps, and specifically the DIEP Flap use your own abdominal tissue to reconstruct the breasts after mastectomy. Surgeons call this an autologous reconstructive procedure, as opposed to using implants.
The researchers analyzed their experience with one type of free flap breast reconstruction, the DIEP flap (deep inferior epigastric artery perforator, or “DIEP” flap.)
The Free Flap Breast Reconstruction Research: The Patient Group
Research scientists studied the outcomes of 208 patients and 339 breast reconstructions in older versus younger women. In medical terms, the scientists, “ The authors conducted a retrospective cohort study composed of a chart review of all deep inferior epigastric perforator flap breast reconstruction patients at a single institution divided into an elderly cohort (65 years or older) and a nonelderly cohort (younger than 65 years).”
The Free Flap Breast Reconstruction Research: The Procedure
1. Complications and risk factors were compared in a group of older women (average age 67 years, 54 flaps) versus younger women (average age 49 years, 285 flaps). Of course, “They noted the older women had substantially higher rates of medical risk factors, including diabetes, high blood pressure, and high cholesterol.”
2. The primary outcome involving the complete or partial loss of the DIEP flap or the need for further flap surgery turned out to be insignificant between the older and younger groups.
3. Researchers granted, “Dehiscence, a type of wound-healing complication, was more common in the older group: nearly 26 percent, compared to eight percent in the younger group.” That can be expected and addressed, prepared for before the surgery like any possibility.
Note A Few Medical Terms about the Complications from DIEP Free Flap Breast Reconstruction
For our deep readers, here are the details, from the Journal of Plastic and Reconstructive Surgery. Concerning the criteria for comparison between the two groups, “The primary outcome measures were complete flap loss, partial flap loss, and need for take-back of the flap. Secondary outcome measures were arterial or venous anastomosis problems; hematoma, seroma, operable fat necrosis, or dehiscence of the breast wound…”Likewise, they recorded possible complications contained in the following list.
- abdominal skin necrosis,
- operable fat necrosis, or
- dehiscence of the abdominal site….”
However, for the purposes of the statistical study, they collected all of these symptoms into one variable, “abdominal wound complications.”
Then, as with any study of any major surgery, medical complications were assessed as outcome measures, including cardiac complications, venous thromboembolism (deep venous thrombosis or pulmonary embolism), pneumonia, and renal failure.”
4. Healing complications related to the flap donor site in the abdomen were similar between age groups.
5. Researchers discovered the absolute risk of complete flap loss was very low: The result is that they found only three cases of flap loss including two in the older group as opposed to one in the younger group. This was true in a total of 339 DIEP flaps
The Outcome: Great Scores for Older Patients
In the final analysis, Dr. Tessler comments, “The overall success rate in our older DIEP flap cases was 96.3 percent – only marginally lower than the 99.6 percent rate in our younger cases.”
We are not viewing this surgery through rose-colored glasses, however. The new study includes findings that show “age 65 or older is associated with some increased risks after breast reconstruction. However, these complications appear at least partly related to the higher rates of medical risk factors among older women.” So, in other words, any major surgery at 65 bears more risk than at 45.
Behind the Big News: Most Important Discovery
The recent research on Free Flap Breast Reconstruction reinforces one aspect of patient care we have always cherished at Altiora Plastic Surgery & Medspa. That is “the importance of assessing the individual patient’s health status – not just age alone – in determining the risks of breast reconstruction.”
Breast cancer is primarily a disease of older women: the median age at diagnosis is 62 years, and more than 40 percent of patients are 65 or older. Although breast reconstruction has important benefits after mastectomy, older women are less likely to undergo this procedure. Some surgeons might perceive that breast reconstruction is riskier in older women, with higher rates of complications and wound healing problems.
Yes, the new study does show that age 65 or older is associated with some increased risks after breast reconstruction. However, these complications appear at least partly related to the higher rates of medical risk factors among older women. The findings reinforce the importance of assessing the individual patient’s health status – not just age alone – in determining the risks of breast reconstruction.
Final Conclusions of the Study and a Holiday Wish
The research scientists ultimately concluded, “we as plastic surgeons must be prepared to consult elderly patients before their mastectomies and be prepared to plan reconstructions in similar fashion to younger patients,” The researchers added, “Although there is an increased risk of flap loss with age, patients 65 years and older can be advised that free flap reconstruction carries an acceptable risk profile in comparison to benefits of the procedure.”
These can be golden words if you are an older woman and cancer survivor. And because you are making decisions about breast reconstruction. At Altiora Plastic Surgery & Medspa, we consider this study to be a breath of fresh air in the midst of old concepts concerning aging. Our surgeon will consult with you, and then, together you will consider treatment based on your specific, individual health conditions, not on your age alone. By the way, there could be no better place to recover than our beautiful city by the sea, Sarasota, FL.
And here is no better time to wish you and your family a Warm and Wonderful Holiday Season! From our Sarasota Altiora Plastic Surgery Family of owners and staff to Yours…