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Advanced Age Is a Predictor of 30-Day Complications after Autologous but Not Implant-Based Postmastectomy Breast Reconstruction

Butz, Daniel R. M.D.; Lapin, Brittany M.P.H.; Yao, Katharine M.D.; Wang, Edward Ph.D.; Song, David H. M.D., M.B.A.; Johnson, Donald M.D.; Sisco, Mark M.D.

Plastic and Reconstructive Surgery: February 2015 - Volume 135 - Issue 2 - p 253e–261e
doi: 10.1097/PRS.0000000000000988
Breast: Original Articles
Press Release
Video Discussion

Background: Older breast cancer patients undergo postmastectomy breast reconstruction infrequently, in part because of a perception of increased surgical risk. This study sought to investigate the effects of age on perioperative complications after postmastectomy breast reconstruction.

Methods: The American College of Surgeons National Surgery Quality Improvement Program Participant Use Files from 2005 to 2012 were used to identify women with breast cancer who underwent unilateral mastectomy alone or with immediate reconstruction. Thirty-day complication rates were compared between younger (<65 years) and older (≥65 years) women after implant-based reconstruction, autologous reconstruction, or mastectomy alone. Linear and logistic regression models were used to control for differences in comorbidities and age.

Results: A total of 40,769 patients were studied, of whom 15,093 (37 percent) were aged 65 years or older. Breast reconstruction was performed in 39.5 percent of younger and 10.7 percent of older women. The attributable risks of breast reconstruction, manifested by longer hospital stays (p < 0.001), more frequent complications (p < 0.001), and more reoperations (p < 0.001), were similar in older and younger women. There were no differences in the adjusted complication rates between older and younger patients undergoing implant-based reconstruction. However, older women undergoing autologous reconstruction were more likely to suffer venous thromboembolism (OR, 3.67; p = 0.02).

Conclusions: The perioperative risks attributable to breast reconstruction are similar in older and younger women. Older patients should be counseled that their age does not confer an increased risk of complications after implant-based breast reconstruction. However, age is an independent risk factor for venous thromboembolism after autologous reconstruction. Special attention should be paid to venous thromboembolism prophylaxis in this group.


Video Discussion by Grant W. Carlson, M.D., is available online for this article.

Chicago and Evanston, Ill.

From the Division of Plastic Surgery, the Division of Surgical Oncology, and the Center for Biomedical Research Informatics, NorthShore University HealthSystem; and the Section of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine.

Received for publication June 9, 2014; accepted July 11, 2014.

A Video Discussion by Grant W. Carlson, M.D., accompanies this article. Go to and click on “Video Discussions” in the “Videos” tab to watch.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Mark Sisco, M.D., Division of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, 501 Skokie Boulevard, Northbrook, Ill. 60062

©2015American Society of Plastic Surgeons