Impact of Preoperative Sarcopenia on Outcomes in Elderly Patients Undergoing Autologous Breast Reconstruction

BACKGROUND: Increased age has been correlated with higher morbidity after autologous breast reconstruction, but it is an incomplete risk predictor. In the oncologic literature, sarcopenia has been associated with increased complications and length of stay. This study investigates preoperative sarcopenia and adverse outcomes in elderly patients undergoing autologous breast reconstruction. METHODS: We conducted a retrospective cohort study of autologous breast reconstruction patients from 2017 to 2024 at a single academic institution. Patients aged 65 and above with preoperative computed tomography angiography (CTA) were included. Sarcopenia was diagnosed by measuring psoas surface area at L3 using preoperative CTA, and the psoas muscle mass index (L3-PMI, cm 2 /m 2 ) was calculated by dividing cross-sectional areas of both psoas muscles by height squared. RESULTS: Two hundred ten patients who underwent autologous breast reconstruction were initially identified. Thirty-four patients with a mean age of 69.7 years (range: 65 to 77) were analyzed as a sarcopenic cohort (n=12) and a nonsarcopenic cohort (n=22). There were no significant differences in mean age (69.76 vs. 71.6, P =0.22), BMI (28.82 vs. 27.96, P =0.66), or medical comorbidities. Reconstruction laterality, timing, and adjuvant treatments were similar between groups. Sarcopenic patients had higher mean daily morphine milligram equivalents (MME) use (35.9 vs. 22.9, P =0.01) and higher total MME use (110 vs. 85.1, P =0.056). Mean length of stay was not significantly different (2.3 vs. 2.54 d, P =0.55). Sarcopenic patients had a higher mean estimated blood loss (218 vs. 136.4 mL, P =0.0493) and larger reduction in mean hemoglobin (3.22 vs. 2.0, P =0.05) without a significant difference in transfusion rate. There were no significant differences in donor-site complications, breast flap complications, or 30-day reoperation rate. Nonsarcopenic patients had a higher rate of breast revision procedures (68.1% vs. 25%, P =0.015). CONCLUSIONS: Abdominal-based autologous breast reconstruction is safe to perform in elderly patients. Preoperative sarcopenia may correlate with greater physiological impact, as indicated by increased narcotic use and blood loss. Overall, they show a similar complication rate compared with nonsarcopenic patients.