A recent study in England concluded that physicians less frequently offer immediate breast reconstruction to older women, despite national guidelines recommending discussions with all mastectomy patients. Past studies have shown that the same problem occurs in the U.S.
Not all mastectomy patients want to have their breasts recreated; some prefer instead to “go flat.” But in either case (and in all cases) women should be the ones who decide what is best for them. They’re the ones who should weigh the consequences, the good and the bad, the potential issues and then make their own informed decisions. But they can’t do that if they don’t know that reconstruction—and especially immediate reconstruction, which has clear advantages over delayed (later) reconstruction—is an option.
Considering that more than 40% of new breast cancer diagnoses are in women older than 60, it’s easy to understand previous estimates showing that 75% of American doctors do not advise women about their reconstructive possibilities—a good portion of that unfortunate statistic undoubtedly involves older women.
Authors of the English study suggested that some doctors might assume that older women aren’t fit enough for reconstructive surgery and recovery, and believe that these women will have worse outcomes. In fact, research shows that older women benefit from breast reconstruction just as younger women do, are just as satisfied with their outcomes, and that post-reconstruction complications among older women aren’t that different than their younger parts. Women well into their 70s and beyond have successful reconstruction.
Though being older doesn’t guarantee you won’t have a problem or two, the more fit you are, the better you’ll weather the experience. (Some women, regardless of their age, may have other health issues that preclude them from having reconstructive surgery.)
Age doesn’t automatically equate to more problems, although older women are more likely to have one or more health conditions that may be problematic when combined with surgery. Compared to younger mastectomy patients, women who are age 60 or older have only slightly more post-surgical issues after implant or tissue flap reconstruction than younger women. Older women, however, have significantly higher risk for venous thromboembolism, a blood clot that develops in a deep vein of the leg or lungs, so certain precautions, including the use of blood-thinning medications, are needed.
Jeevan R, Browne JP, Gulliver‐Clarke CJ, et al. " Association between age and access to immediate breast reconstruction in women undergoing mastectomy for breast cancer.” British Journal of Surgery. Published online February 8, 2017. (https://www.bjs.co.uk/article/association-between-age-and-access-to-immediate-breast-reconstruction-in-women-undergoing-mastectomy-for-breast-cancer/)
Gibreel W, Heins CN, Hoskin TL, et al. “Mastectomy and Immediate Breast Reconstruction for Cancer in the Elderly: A National Cancer Data Base Study.” Journal of the American College of Surgeons 223(4); 2016: Supplement 2, Page e3.
Santosa KB, Qi J, Hyungjin KM, et al. “Effect of Patient Age on Outcomes in Breast Reconstruction: Results from a Multicenter Prospective Study.” Journal of the American College of Surgeons 223 (6); 2016: 745-54.