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

Background: Nipple-sparing mastectomy (NSM) is infrequently performed in older women, at least in part owing to concerns regarding age-related complications. We describe postoperative outcomes of NSM in older women and risk factors for complications, with the goal of informing patient selection and decision-making.

Patients and methods: Cases of NSM with immediate implant-based reconstruction were identified from an institutional database (2009-2019). Patient characteristics and postoperative complications were compared between women 45-54 years, 55-64 years, and ≥ 65 years. Regression models were used to identify risk factors for serious complications and reconstruction failure.

Results: Of 1998 NSMs in 1197 women, 1296 were in women 45-54 years, 521 in women 55-64 years, and 181 in women ≥ 65 years. Women ≥ 65 years had higher rates of comorbidities and more frequently incurred early postoperative complications (11% versus 7.3% in 55-64 years and 5.2% in 45-54 years, p = 0.005), particularly hematoma (5.0% versus 1.5% in 55-64 years and 1.2% in 45-54 years, p < 0.001). On univariate analysis, unadjusted rates of infection, necrosis, serious complications, and reconstruction failure did not differ significantly by age. Permanent reconstruction failure occurred in eight (4.4%) women ≥ 65 years. On multivariable analysis, age was not an independent predictor of serious complications or reconstruction failure, though current smoking, in addition to factors more common in older women (diabetes, hypertension, anticoagulation, prior radiotherapy), emerged as independent risk factors.

Conclusions: After adjusting for patient factors, older age did not increase risk of complications after NSM. Studies on functional and quality-of-life outcomes may help further refine patient selection and facilitate decision-making.