How Does Your Age Impact Your Breast Reconstruction Choices?
It is a misconception that patients can be “too old” for breast reconstruction. Age is only one of many factors surgeons take into account when determining if a patient is a good candidate for surgery. In addition, some older women are under the impression their only option is implants. However, this is not necessarily the case either.
What is DIEP flap breast reconstruction?
Ideally, ALL breast reconstruction options should be available to older women. This includes the most advanced breast reconstruction procedure available today—the DIEP flap. The DIEP flap uses the patient’s own lower abdominal skin and fat to recreate a warm, soft, “natural” breast after a mastectomy. The DIEP preserves all the abdominal muscles allowing patients to experience less pain, recover quicker, and maintain their core strength long-term. Sparing the abdominal muscle also lowers the risk of abdominal complications.
Age alone does not disqualify a patient from being a DIEP flap candidate. In fact, a recent study took a closer look at how older women undergoing DIEP flap reconstruction compared to younger women having the procedure. Here’s what the study uncovered…
Is the DIEP flap a good option for older women?
After following 83 DIEP flap breast reconstruction patients over the age of 65, the study found these older patients had similar success and complication rates to younger patients. Likewise, older woman expressed a high satisfaction rate after choosing the surgery.
The authors of the study concluded that the DIEP flap is a safe option for older women and the procedure should be encouraged for breast reconstruction in women over 65 years of age.
“This is something I see reflected in my own practice,” shares Breast Advocate® founder Dr. Minas Chrysopoulo. “Age is only one of many factors I take into consideration when determining which breast reconstruction procedure is best for a patient. Personal motivation as well as physiological age are more important criteria for patient selection than chronologic age alone. Overall health status is far more important. Many of my patients over 65 are very good DIEP flap candidates.”
Ultimately, the best way to determine if you are a candidate for the DIEP flap is to be evaluated by a surgeon experienced in performing these procedures.
Does Chemotherapy Increase the Risk of Breast Reconstruction Complications?
For anyone interested in having breast reconstruction, trying to decide the best time to have it can be yet one more overwhelming decision. Generally speaking, you can have reconstruction at the same time as the mastectomy (this is called immediate reconstruction), or any time later (known as delayed reconstruction). Several factors can influence the timing of breast reconstruction surgery. These can include personal choice, access to a plastic surgeon, and other breast cancer treatments like chemotherapy and radiation.
Does Chemotherapy Impact Breast Reconstruction Planning?
Numerous studies show a higher risk of breast reconstruction complications in patients who have radiation, but the impact of chemotherapy on reconstruction is not as clear.
Chemotherapy can be given before surgery (known as neoadjuvant) or after surgery (adjuvant). A recent study published in JAMA Surgery followed 1881 women undergoing breast reconstruction (both implant-based and with autologous flaps). The study evaluated complication rates and patient reported outcomes. Chemotherapy (either before or after surgery) did not increase the risk for complications in patients undergoing breast reconstruction, regardless of technique. Likewise, there was no link between chemotherapy and any adverse patient satisfaction scores or poor psychosocial well-being.
When is the Best Time to Schedule Your Breast Reconstruction?
This information can help empower women needing to make informed decisions regarding breast reconstruction timing in the setting of chemotherapy.
Patients should engage in shared decision-making conversations with their healthcare team to determine the best time for their breast reconstruction based on their individual needs and clinical situation.
For patients looking for help navigating breast reconstruction timing questions with their surgeons, the Breast Advocate® app can help! After taking users individual situation and preferences into account, the treatment Wizard provides evidence-based recommendations to review and discuss with your healthcare team. Download the free app today HERE.
Breast Cancer Patients Needing Radiation Therapy Face Higher Risk of Implant Reconstruction Complications Requiring Additional Surgery
Implant-based breast reconstruction is the most commonly performed method of reconstruction in the United States today. While the procedure can be performed in one surgery (known as ‘direct to implant’), most women have a 2-stage approach beginning with tissue expanders. These are replaced with a permanent implant a few months later at a second surgery (stage 2).
Implants are a good option for many women but may not be the best choice for some patients. In particular, patients needing radiation therapy as part of their breast cancer treatment should know that radiation increases the risk of complications after reconstruction with implants. Potential complications include infection, capsular contracture (breast hardening), asymmetry, seroma, pain, implant rupture, and implant exposure. In many cases, additional surgery is required to address the complication.
Implants often need to be removed
A recent study published in The Breast Journal found that 44% of women with locally advanced breast cancer who had implant reconstruction needed unplanned implant removal when radiation therapy was part of their treatment plan.
The study followed 52 patients who had mastectomy, implant-based breast reconstruction, and radiation therapy from 2010 to 2017. 44% of the patients in the study had stage III disease, 77% were estrogen receptor positive, and 75% were HER2 positive.
Patients were followed for just over 3 years following surgery and treatment. The average time between treatment and implant removal was only 5 months. In this study, implant removal was required before starting radiation in 17% of the patients, and after radiation was completed in 27% of the patients.
Reasons for implant removal before radiation began were infection (44%), wound breakdown (33%), hematoma (11%), and concern about planned radiation (11%). Reasons for implant removal after radiation included significant breast asymmetry (57%), infection (21%), a deflated expander (14%), and seroma (7%). Some women had bilateral mastectomy and reconstruction – most of the complications in these cases occurred in the breast that underwent radiation therapy.
This study is yet another example of why it is important for patients to be fully informed of the potential risks associated with surgery they choose. Fully-informed patients also tend to have more realistic expectations, which in turn can also improve recovery and the overall satisfaction with the final outcome.
You have other options!
Fortunately, implants are not the only reconstructive option and most women are candidates for alternative procedures. These include other types of breast reconstruction using the patient’s own tissue (known as ‘flaps’), and aesthetic flat closure (going flat).
“Despite the relatively high rate of implant removal reported in this study, salvage reconstruction is feasible,” the study authors noted. “Of the 23 patients who experienced unplanned implant removal, 78% were able to undergo salvage reconstruction with only 5 patients pursuing no further reconstruction at the time of last follow-up.”
If you are facing a similar situation and would like to learn more about your options, the Breast Advocate app can help – download it today!
