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 DIEP flap breast reconstruction increase the risk of breast cancer recurrence?
Patients choosing to undergo breast reconstruction are often concerned that their decision may increase their risk of breast cancer recurrence. A recent study published in the British Journal of Surgery looked at the risk of recurrence specifically after DIEP flap reconstruction.
The study compared 250 patients who had DIEP flap reconstruction between 1999 and 2013 with more than 700 control patients. Breast cancer recurrence was seen in over 19 percent of patients who had DIEP flap surgery and over 23 percent of patients in the control group. Interestingly, the 5-year breast cancer-specific survival rate was highest in patients having DIEP flap surgery after 2008 – 92.4 percent in the DIEP flap group versus 87.4 percent in the control group.
The study design does raise some questions about selection bias. For example, all DIEP flap procedures in this study were performed at least 24 months after mastectomy. No DIEP flaps were performed at the same time as the mastectomy (‘immediate’ reconstruction). In addition, a larger number of patients in the DIEP flap group than the control group received adjuvant therapy.
While the survival rates between groups may have been influenced by patient selection, this study shows that patients with breast cancer undergoing DIEP flap breast reconstruction do NOT have a higher rate of breast cancer recurrence than patients undergoing mastectomy alone.
Shannen Doherty Undergoes “Stacked” DIEP Flap Breast Reconstruction Following Mastectomy
After being in remission from breast cancer for a year, Shannen Doherty underwent breast reconstruction surgery in May, reports People magazine.
She chose DIEP flap reconstruction. This procedure uses a patient’s own skin and fat from the lower tummy to recreate the breast following a mastectomy. Because of Doherty’s thin physique, she had to gain a little weight before surgery. The surgeon performed what is referred to as a “Stacked DIEP” which is a great option for thin patients. The stacked DIEP flap procedure uses tissue from both sides of the lower abdomen to reconstruct a single breast. The standard DIEP flap procedure uses one side of the abdomen to reconstruct each breast.
Usually, when women select DIEP flap surgery they are looking for the best long-term solution to breast reconstruction since tissue reconstructions age with them — the reconstructed breast(s) gain weight when they gain weight and lose weight when they lose weight. The tissue ages more naturally and, unlike implants, these reconstructions never need to be redone.
It is important for patients to know implants are not the only option for reconstructive surgery. Unfortunately, advanced procedures like the DIEP flap are not offered by all reconstructive plastic surgeons since extensive experience in microsurgery is required to perform these surgeries successfully. Patients must therefore do their homework in finding surgeons with the appropriate expertise.
