Older age may predict expedited care for motivated breast reconstruction patients

Background

While outcomes and satisfaction with breast reconstruction are similar across ages, older patients have lower utilization rates. This study examines age-related differences in care timelines and surgery length to identify factors driving this disparity.

Methods

Data was collected on breast reconstruction patients from 2017 to 2023. Outcomes included index and aggregate procedure durations, as well as intervals between breast cancer diagnosis and Plastic Surgery (PS) consultation, index reconstructive procedure, and final reconstructive procedure. Multivariate regression was used to analyze both absolute age and age-quartile mediated differences in outcomes.

Results

1659 patients were divided into age-based quartiles (Q): Q1 (15.8–44.2 years, mean=38, n=415), Q2 (44.2–52.1, mean=48; n=415), Q3 (52.1–60.6, mean=56; n=416), and Q4 (60.6–85.4, mean=67; n=413). Insurance type, reconstruction modality and comorbidity burdens differed significantly between quartiles, with the latter highest among Q4 patients. Multivariate regression showed that increasing age predicted shorter index (β=−0.002, P=0.019) and aggregate (β=−0.002, P=0.005) procedure durations. Regarding clinical timelines, increasing age predicted shorter intervals between diagnosis and final operation (β = −0.006, p = 0.013). In addition, Q2 (β = −0.263, p = 0.046) and Q4 patients (β = −0.625, p = 0.021) showed shorter intervals between diagnosis and PS consult compared to Q1 patients.

Conclusion

Older patients undergoing breast reconstruction experience shorter operative durations and faster reconstruction completion than their younger counterparts. This may reflect greater motivation and fewer aesthetic concerns among suitable candidates, or a deliberate emphasis by surgeons on efficiency to minimize anesthesia exposure.