Free flap breast reconstruction in advanced age: is it safe?

BACKGROUND: Due to perceived medical and surgical risk, patients of advanced age may not be offered free flap breast reconstruction. The purpose of this study was to determine whether complications are actually higher in patients of advanced age.
METHODS: A review of 1031 muscle-sparing free transverse rectus abdominis musculocutaneous, deep inferior epigastric perforator, and superficial inferior epigastric artery flaps over 15 years was performed. There were 976 patients younger than 65 years and 55 patients aged 65 and older. Population variables, operative variables, and outcome variables were compared. Statistical analysis included chi-square, Fisher's exact, Mann-Whitney, and two-sample t tests.
RESULTS: The mean age was 47 years (range, 24 to 79 years). The older group had a higher American Society of Anesthesiologists status (2.1 versus 1.9; p = 0.05), a higher prevalence of hypertension (38 percent versus 18 percent; p < 0.001), a higher average body mass index (30 versus 28; p = 0.039), and lower rates of preoperative (28 percent versus 13 percent; p = 0.016) and postoperative (17 percent versus 2 percent; p = 0.003) chemotherapy. In the older group, more blood transfusions (7 percent versus 2 percent; p = 0.03) were administered and the coupler was used less often (13 percent versus 32 percent; p = 0.009). There was no difference in length of stay (3.5 days), medical complications (4 percent), surgical complications (32 percent), take-backs (1 percent), or revisions (19 percent).
CONCLUSIONS: Despite higher rates of hypertension, higher American Society of Anesthesiologists status, higher body mass index, and higher rates of blood transfusion, the 65 years and older group had outcomes equal to those of the general population. Thus, free flap breast reconstruction in patients of advanced age is safe, and should be offered when indicated.