Kim Minji, Ali Barkat, Zhang Kevin, Vingan Perri, Boe Lillian, Ly Catherine L, Allen Robert J, Stern Carrie S, Matros Evan, Cordeiro Peter G, Mehrara Babak, Nelson Jonas A
From the Plastic and Reconstructive Surgery Service, Department of Surgery.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center.
Plast Reconstr Surg. 2025 Jan 1;155(1):22-31. doi: 10.1097/PRS.0000000000011554. Epub 2024 May 21.
Although the current literature indicates that age should not be a deterring factor in postmastectomy breast reconstruction, the true impact of increasing age on postoperative outcomes remains unknown. The purpose of this study is to understand the impact of age on complications and patient-reported outcomes (PROs) using the BREAST-Q longitudinally 5 years after postmastectomy breast reconstruction.
The authors conducted a retrospective analysis of patients who underwent autologous (ABR) or implant-based reconstruction (IBR). Age was studied as both a categorical and a continuous variable. Outcome measures included complications and BREAST-Q scores preoperatively, at 6 months, and 1 to 5 years postoperatively.
A total of 4730 patients were included, of which 1536 (32.5%) underwent ABR and 3194 (67.5%) underwent IBR. Older age was significantly associated with increased risk of developing mastectomy skin flap/nipple necrosis, infection, and seroma. Older age was negatively correlated with Satisfaction with Breasts (β = -0.06 [95% CI, -0.12 to -0.01]; P = 0.033) and positively correlated with Psychosocial Well-being (β = 0.14 [95% CI, 0.09 to 0.20]; P < 0.001). Older age was not correlated with Physical Well-being of the Chest (β = -0.03 [95% CI, 0.08 to 0.02]; P = 0.2) or Sexual Well-being (β = -0.04 [95% CI, -0.12 to 0.02]; P = 0.2). Subgroup analyses of ABR and IBR patients demonstrated different complications and PRO profiles.
The authors' analysis of the impact of age on surgical outcomes and PROs suggests that complication rates increase with age, and older age is negatively correlated with Satisfaction with Breasts but positively correlated with Psychosocial Well-being. Overall, older patients should be informed about the potential associated risks and anticipated PROs.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
尽管当前文献表明年龄不应成为乳房切除术后乳房重建的阻碍因素，但年龄增长对术后结果的真正影响仍不明确。本研究的目的是通过BREAST-Q纵向评估乳房切除术后乳房重建5年后年龄对并发症和患者报告结局（PROs）的影响。
作者对接受自体乳房重建（ABR）或假体植入乳房重建（IBR）的患者进行了回顾性分析。将年龄作为分类变量和连续变量进行研究。结局指标包括术前、术后6个月以及术后1至5年的并发症和BREAST-Q评分。
共纳入4730例患者，其中1536例（32.5%）接受了ABR，3194例（67.5%）接受了IBR。年龄较大与乳房切除皮瓣/乳头坏死、感染和血清肿发生风险增加显著相关。年龄较大与乳房满意度呈负相关（β = -0.06 [95% CI，-0.12至-0.01]；P = 0.033），与心理社会幸福感呈正相关（β = 0.14 [95% CI，0.09至0.20]；P < 0.001）。年龄较大与胸部身体幸福感（β = -0.03 [95% CI，0.08至0.02]；P = 0.2）或性幸福感（β = -0.04 [95% CI，-0.12至0.02]；P = 0.2）无关。对ABR和IBR患者的亚组分析显示了不同的并发症和PROs特征。
作者对年龄对手术结局和PROs影响的分析表明，并发症发生率随年龄增长而增加，年龄较大与乳房满意度呈负相关，但与心理社会幸福感呈正相关。总体而言，应告知老年患者潜在的相关风险和预期的PROs。
临床问题/证据水平：风险，II级。
