Outcomes of free flap breast reconstruction in patients aged 70 years and over: A single-centre experience

Background

Chronological age is an important factor in determining whether a patient can be offered reconstruction following breast cancer surgery. Free flap breast reconstruction is considered the gold standard but is seldom offered to older patients, as the risks are considered too high. This study aimed to examine the outcomes of free flap breast reconstruction in patients aged ≥70 years treated in our unit.

Methods

We conducted a retrospective review examining the outcomes of consecutive patients aged ≥70 years undergoing free flap breast reconstruction at a single centre between January 2015 and December 2023. Logistic regression was used to determine the relationship between increasing age and comorbidities, and four primary outcome variables— all complications, readmission, return to theatre and length of stay.

Results

We identified 71 patients with a mean age of 72.3 years (70–78 years). 63.4% had one or more comorbidities, with the most common being hypertension and hypercholesterolaemia. Most patients (90.1%) were American Society of Anesthesiologists (ASA) grade 1 or 2. The overall complication rate was 36.6%, most of which were minor wound healing complications (22.5%). There were no episodes of flap loss, either partial or complete. The rates of severe complications (14.1%), readmission (8.4%) and return to theatre (7.0%) were low and comparable to those previously published for our general patient cohort. There was no relationship between increasing age beyond 70 years and any of the four primary adverse outcome measures.

Conclusions

Free flap breast reconstruction in patients aged ≥70 years can be successful and safe. Therefore, it should be considered as an option for fit, surgically optimised patients, independent of age.