Is There an Age Limit for Breast Reconstruction After Cancer?

“Seventy is the new fifty.” That’s not just a saying, it’s an actual statistic from a recent survey on age perception, conducted by TD Ameritrade. They found more than 70 percent of women believe this age adjustment is true. Times have certainly changed, considering that a child born in 1900 was only expected to live to be about 50-years old. Today women are not only living longer, they are living with more vitality, throwing out old edicts to dress and act “their age.”

Much of this is thanks to incredible advances in medicine, and breast cancer survival is a germane example. A once deadly killer now has survival rates upward of 90 percent. This leaves more women than ever before deciding how they want to live their lives following mastectomy. For many this means choosing breast reconstruction. According to this government report, in the last decade breast reconstruction has increased among all age groups but “disproportionately so for women aged 65 years and older.”

All this has led researchers (and many women) to ask the question: Is breast reconstruction more dangerous for older women than it is for those who are younger? An analysis published this month (June 2019) in the journal Breast Cancer Research and Treatment specifically asked the question “Is immediate breast reconstruction safe in women over 70?”

The researchers reviewed data collected between 2005 and 2016 in the United States on how women in this age group fared in the 30 days after breast reconstruction and compared that to those 18-69 years old. All women (older and younger) in the study had been diagnosed either with breast cancer that was in situ (contained within the breast) or invasive (also spread to another part of the body).

Most of the women in the study (28,000 of them) had undergone an implant-based reconstruction, while others (9,000 of them) underwent autologous reconstruction. Here is the difference between these two types of breast reconstruction, commonly performed following mastectomy of one or both breasts:

Implant-based breast reconstruction
A breast mound is constructed using breast implants. These may be filled with silicone gel, saline, or a combination of the two. Implants may allow for larger breasts, but they may not look and feel as much like a woman’s natural breasts.

Autologous breast reconstruction
A breast mound is constructed using tissue taken from the patient’s own body. Tissue may be taken from the patient’s thigh, back, buttocks, or abdomen. Autologous reconstruction may result in softer more natural looking breasts, but a second surgical site is needed for harvesting the graft tissue.

Dr. Slack performs both of these types of procedures and while more women choose implant-based reconstruction (as they did in the research study), the choice is personal and should be made with the help of a qualified plastic surgeon experienced with breast reconstruction.

In total, nearly 40,000 women were included in the study, nearly 2,500 of those were women 70-years and older. In other words, significantly more younger women underwent reconstruction than did older women (not surprising since this surgical option has only recently been open to older women). Nonetheless, the scientists were able to compare complication and death rates between the two groups during the 30 days following their procedures.

Their analysis took into account the fact that the older women in the study were more likely to have what are called co-morbidities. These include age-related and other health issues like high blood pressure, diabetes, or heart disease, that are not due to a diagnosis of breast cancer. After accounting for these issues, the researchers found complications were more or less equal between groups, and death within 30 days of breast surgery was rare in either group.

Here is the take-away: Any increased risk for a woman age 70 and above has more to do with her health than her age.

If you have read our blog much, you will likely know that Dr. Slack puts a big priority on health screening before any kind of plastic surgery. He encourages all his patients to do as much as they can to boost their health through diet and lifestyle, smoking cessation, and weight management before and after surgery. This helps ensure fewer complications and a better outcome— this goes for women (and men) of any age.

If you are considering breast reconstruction following mastectomy and have concerns about your age, make an appointment today to talk to Dr. Slack. He will give you an honest and carefully considered answer.

Timing Your Breast Reconstruction After Mastectomy

Breast reconstruction isn’t for everyone. Tig Notaro, for example.

After her double mastectomy without reconstruction, the dry-witted comedian embraced her new body and performed topless (for a full 20 minutes!) in her 2015 HBO special Boyish Girl Interrupted. If you aren’t as willing to accept a new life without breasts, reconstruction may be an easy choice for you. Even if you aren’t 100 percent sure whether you will want a breast reconstruction, do your due diligence now because timing matters if you want to achieve optimal results.

Here’s what the American Cancer Society has to say about that:

“If you are thinking about having reconstructive surgery, it is best to talk about it with your surgeon and a plastic surgeon experienced in breast reconstruction before you have surgery to remove the tumor or breast. This lets the surgical teams plan the best treatment for you, even if you decide to wait and have reconstructive surgery later.”

Breast reconstruction is most often performed at the same time as mastectomy (immediate reconstruction), but it can also be done years later (delayed reconstruction). In other words, though you shouldn’t wait to get informed, you don’t have to decide whether to have the surgery right away. With everything you have to think about before a mastectomy, it can be overwhelming to have to make a decision about reconstruction too. Your doctors may also recommend you wait if you are continuing with radiation treatment.

Here are some other reasons to delay reconstruction.

You are a smoker

Cigarettes and other tobacco products contain hundreds of toxic chemicals, including nicotine, hydrogen cyanide, and carbon monoxide. They leave your body with an overall shortage of oxygen and make it harder to heal. Smokers are more likely to suffer from complications, like an infection or blood clot, during or after surgery.

While claims have been made that e-cigarettes are a healthier alternative, this does not make them safe. Toxic metals like lead, chromium, manganese and nickel have been detected in their vapor. Read more about vaping and plastic surgery in this post.

Most plastic surgeons will require that you quit smoking at least four weeks before surgery.

You have other health problems

Cancer may not be the only health problem you are dealing with. Conditions such as obesity, diabetes, heart disease, stroke, high blood pressure, sleep apnea, or other breathing problems can impair your body’s ability to withstand the stresses of another surgery.

Your plastic surgeon will likely require that conditions like these be managed and well under control before undergoing breast reconstruction.

You haven’t found the right plastic surgeon

Your oncologist or surgeon will likely be able to refer you to a qualified plastic surgeon before your mastectomy. Take the opportunity to meet with them as soon as possible. You want to do your homework to make sure the surgeon is right for you. Your plastic surgeon should be board certified and have hospital privileges at a reputable facility you have access to.

Breast reconstruction is complicated and no two surgeries will be the same. You will need someone (like Dr. Slack) who has specific training and experience in breast reconstruction surgery and is able to discuss the options available to you.

Whether and when to have breast reconstruction after mastectomy is a very personal decision. One that you need to make with your healthcare team, including a plastic surgeon. Maybe, like Tig and many other women, you will decide to go flat, or maybe reconstruction is a no brainer for you. As long as you are informed, there is no wrong choice. You do you—shirt off, or on, or somewhere in between.

If you have any questions or want to learn more about breast reconstruction, contact our office today