The Age-Old Question in Nipple-Sparing Mastectomy: Is Older Age a Contraindication?

Area of Science:

• Oncology
• Plastic Surgery
• Geriatric Medicine

Background:

• Nipple-sparing mastectomy (NSM) is underutilized in older women due to concerns about age-related complications.
• This study evaluates postoperative outcomes and risk factors for NSM in older populations.

Purpose of the Study:

• To assess the safety and complication rates of NSM with immediate implant-based reconstruction in older women.
• To identify risk factors for complications and reconstruction failure in this demographic.

Main Methods:

• Retrospective review of 1998 NSMs with immediate implant reconstruction (2009-2019).
• Comparison of outcomes across age groups: 45-54, 55-64, and ≥65 years.
• Multivariable regression analysis to identify independent risk factors for complications and reconstruction failure.

Main Results:

• Women aged ≥65 years had higher rates of comorbidities and early postoperative complications, particularly hematoma.
• Univariate analysis showed no significant difference in infection, necrosis, serious complications, or reconstruction failure by age.
• Multivariable analysis revealed that age was not an independent predictor; smoking, diabetes, hypertension, anticoagulation, and prior radiotherapy were significant risk factors.

Conclusions:

• Advanced age is not an independent risk factor for complications or reconstruction failure following nipple-sparing mastectomy.
• Patient-specific factors, such as smoking and comorbidities, are more critical in predicting outcomes.
• Further research on functional and quality-of-life outcomes can refine patient selection for NSM in older women.