Risk of Venous thromboembolism higher after autologous breast reconstruction in women over age 65

Women who are 65 or older are often thought to be at more risk for complications after breast reconstruction, but a new study shows that isn’t necessarily the case.

Analyzing records for 40,769 women who had unilateral mastectomy between 2005 and 2012, researchers identified 15,093 women who were age 65 or older at the time of their surgery; almost 11% of these older women had breast reconstruction, compared to 39.5% of mastectomy patients who were younger than age 65.

When researchers compared 30-day complication rates between the two age groups, they found:

• complication rates were similar among women who had reconstruction with breast implants.
  
  
• for the most part, rates of post-surgical complications after autologous tissue flap reconstruction (with a woman's own natural tissue)—longer hospital stays, more frequent complications, and more re-operations—was similar: about 7% of the older women developed post-surgical complications after breast reconstruction, compared to about 5% of younger women.
  
  
• women in the 65+ group who had autologous reconstruction were more likely to suffer venous thromboembolism than their younger counterparts.
  

Venous thromboembolism (VTE) is a blood clot that forms in the leg or lung that breaks loose and travels in the blood. Overall, the rate of VTE among women who had autologous breast reconstruction was just 1%. Women who were 65 and older developed VTE 4 times more often than their younger counterparts; women between ages 70 and 75 developed the same problem 6 times more often.

Study authors suggested that, "Older patients should be counseled that their age does not confer an increased risk of complications after implant-based post-mastectomy breast reconstruction. However, they should be counseled that their age may confer an increased risk of VTE.”

The somewhat higher risk of VTE doesn’t necessarily preclude older women from having autologous breast reconstruction, but it does indicate that more precautions, such as the use of blood-thinning medications, should be taken with older women.

Source: Butz DR, Lapin B, Yao K, et al. “Advanced age is a predictor of 30-day complications after autologous but not implant-based postmastectomy breast reconstruction.” Plastic and Reconstructive Surgery. 2015 Feb; 135(2):253e-61e.

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