Mastectomy and Immediate Breast Reconstruction for Cancer in the Elderly: A National Cancer Data Base Study

Mastectomy with immediate breast reconstruction (M+IBR) is performed increasingly for breast cancer treatment, but whether this trend extends to the growing number of women diagnosed at age 65 or older is unknown. We studied the effects of age and comorbidities on the use and outcomes of M+IBR.

Patients undergoing mastectomy for breast cancer were ascertained from the National Cancer Data Base 2004 to 2012. Performance of M+IBR and outcomes were compared by age group (<65 years vs ≥65 years) and other patient and tumor factors.

There were 364,767 patients who underwent mastectomy, of whom 127,501 (35.0%) had IBR. Among M+IBR patients, 10.3% were age 65 or older, including 1.5% who were 75 or older. From 2004 to 2012, M+IBR increased from 6.7% to 18.1% in women 65 or older (p < 0.001), paralleling the increase in women less than 65 years (32.9% to 57.3%; p < 0.001). Contralateral prophylactic mastectomy rates in M+IBR patients were lower in patients 65 or older (27.4%) than in those less than 65 (45.9%), p < 0.001. A Charlson-Deyo score > 0 (any comorbidity) was more frequent in patients 65 or older having mastectomy alone (27.0%) vs M+IBR (18.4 %) (p < 0.001). Among M+IBR patients, the Charlson-Deyo score was >0 in 18.4% of patients 65 or older vs 9.8% among patients less than 65 (p < 0.001). Thirty-day unplanned readmission rates were higher for older patients: 3.7% vs 2.9% for M+IBR patients 65 or older vs less than 65, respectively, even those with a Charlson-Deyo score = 0, 3.5% vs 2.8% (both p < 0.001).

Rates of M+IBR rates are increasing, with 10% of M+IBR patients now age 65 or older. Higher 30-day unplanned readmission rates in elderly M+IBR patients with or without comorbidities suggest the need to establish criteria for safe M+IBR in these patients.