Recent studies have documented a marked increase in the use of immediate breast reconstruction (IBR) following mastectomy for treatment of breast carcinoma. However, this increase has translated unequally among all age groups, with elderly patients receiving proportionally fewer reconstructions. Herein, we attempt to address this discordance through a retrospective review of patients undergoing mastectomy secondary to newly diagnosed breast cancer.

With IRB approval, an extensive review of medical records of all patients presenting to the Thomas Jefferson University Hospital, Dept. of Surgery from 1999 to 2005 was conducted to identify women who underwent mastectomy as a result of newly diagnosed breast carcinoma. Patient demographics, indications for surgery and decisions regarding IBR were reviewed.

We identified 4330 female patients diagnosed with breast cancer, of whom 1090 underwent mastectomy. 24% of these mastectomized women went on to receive IBR. Of the reconstructions performed, 38% of women received tissue expanders alone, while 29% received transverse rectus abdominus myocutaneous flaps and 33% received latissimus dorsi myocutaneous flaps (LDMF). 25% of women who elected IBR were over the age of 65. Within our entire cohort of women aged 65 to 69, 70 to 75 and over 75, 30%, 22% and 1%, respectively, received IBR. Since 2001, LDMF has been our preferred reconstructive technique with over 60% of all women undergoing IBR opting for this procedure. 90% of women over the age of 65 were discharged by the fourth postoperative day, with approximately 3% peri-operative morbidity and no mortalities as of the most recent follow-up.

Low rates of IBR following mastectomy in elderly women have been attributed to concerns regarding difficulty in detecting local disease recurrence, efficacy of adjuvant therapy, prolonged surgery, increased post-reconstruction complications and increased co-morbidities, among others. In our study, we found the percentage of elderly women receiving IBR following mastectomy was significantly higher as compared to other published studies. Moreover, these women experienced post-operative morbidity and mortality rates similar to the younger patients in our cohort. As a result, we believe physicians and patients, in particular those women over age 65, need to be properly educated regarding the surgical options, minimal associated morbidity and mortality, and excellent functional and cosmetic outcomes associated with IBR. Future management guidelines should certainly include IBR in the algorithm.