Browse > Article
http://dx.doi.org/10.1055/s-0042-1744405

Postmastectomy Breast Reconstruction is Safe in Patients on Chronic Anticoagulation  

Yan, Maria (Division of Plastic and Reconstructive Surgery, Mayo Clinic)
Kuruoglu, Doga (Division of Plastic and Reconstructive Surgery, Mayo Clinic)
Boughey, Judy C. (Division of Breast Melanoma Surgical Oncology, Mayo Clinic)
Manrique, Oscar J. (Division of Plastic Surgery, University of Rochester)
Tran, Nho V. (Division of Plastic and Reconstructive Surgery, Mayo Clinic)
Harless, Christin A. (Division of Plastic and Reconstructive Surgery, Mayo Clinic)
Martinez-Jorge, Jorys (Division of Plastic and Reconstructive Surgery, Mayo Clinic)
Nguyen, Minh-Doan T. (Division of Plastic and Reconstructive Surgery, Mayo Clinic)
Publication Information
Archives of Plastic Surgery / v.49, no.3, 2022 , pp. 346-351 More about this Journal
Abstract
Background Postmastectomy breast reconstruction (PMR) increases patient satisfaction, quality of life, and psychosocial well-being. There is scarce data regarding the safety of PMR in chronic anticoagulated patients. Perioperative complications can reduce patient satisfaction; therefore, it is important to elucidate the safety of PMR in these patients. Methods A retrospective case-control study of patients who underwent PMR with implants and were on chronic anticoagulation was performed at our institution. Inclusion criteria were women ≥ 18 years old. Exclusion criteria included autologous reconstructions, lumpectomy, and oncoplastic procedures. Two controls for every one patient on anticoagulation were matched by age, body mass index, radiotherapy, smoking history, type of reconstruction, time of reconstruction, and laterality. Results From 2009 to 2020, 37 breasts (20 patients) underwent PMR with implant-based reconstruction and were on chronic anticoagulation. A total of 74 breasts (40 patients) who had similar demographic characteristics to the cases were defined as the control group. Mean age for the case group was 53.6 years (standard deviation [SD] = 16.1), mean body mass index was 28.6 kg/m2 (SD = 5.1), and 2.7% of breasts had radiotherapy before reconstruction and 5.4% after reconstruction. Nine patients were on long-term warfarin, six on apixaban, three on rivaroxaban, one on low-molecular-weight heparin, and one on dabigatran. The indications for anticoagulation were prior thromboembolic events in 50%. Anticoagulated patients had a higher risk of capsular contracture (10.8% vs. 0%, p = 0.005). There were no differences regarding incidence of hematoma (2.7% vs. 1.4%, p = 0.63), thromboembolism (5% vs. 0%, p = 0.16), reconstructive-related complications, or length of hospitalization (1.6 days [SD = 24.2] vs. 1.4 days [SD = 24.2], p = 0.85). Conclusion Postmastectomy implant-based breast reconstruction can be safely performed in patients on chronic anticoagulation with appropriate perioperative management of anticoagulation. This information can be useful for preoperative counseling on these patients.
Keywords
postmastectomy reconstruction; breast reconstruction; anticoagulation; warfarin; heparin;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Santosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Long-term patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg 2018;153(10):891-899   DOI
2 American Society of Plastic Surgeons (ASPS) 2018 National Plastic Surgery Statistics [Internet]. Arlington Heights, IL: ASPS; 2019. Accessed February 3, 2022 at: https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-report-2018.pdf
3 Yan M, Landin Jarillo L. Safety and effectiveness of breast reconstruction in anticoagulated patients. J Breast Sci 2020;33:16-22
4 Richards K, Forouhi P, Johnston A, Malata CM. Pre-operative thrombotic complications of neoadjuvant chemotherapy for breast cancer: implications for immediate breast reconstruction. Ann Med Surg (Lond) 2014;4(01):80-84
5 Schwartz JC, Skowronski PP. Case report of a definitive autologous reconstruction in a patient requiring immediate postoperative anticoagulation and reduced operative time. Int J Surg Case Rep 2016;25:86-88   DOI
6 Bachour Y, Bargon CA, de Blok CJM, Ket JCF, Ritt MJPF, Niessen FB. Risk factors for developing capsular contracture in women after breast implant surgery: a systematic review of the literature. J Plast Reconstr Aesthet Surg 2018;71(09):e29-e48   DOI
7 Thorarinsson A, Frojd V, Kolby L, Liden M, Elander A, Mark H. Patient determinants as independent risk factors for postoperative complications of breast reconstruction. Gland Surg 2017;6(04):355-367   DOI
8 Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol 2014;32(09):919-926   DOI
9 Barnes GD, Lucas E, Alexander GC, Goldberger ZD. National trends in ambulatory oral anticoagulant use. Am J Med 2015;128(12):1300-5.e2   DOI
10 Mozaffarian D, Benjamin EJ, Go AS, et al; Writing Group Members American Heart Association Statistics Committee Stroke Statistics Subcommittee. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 2016;133(04):e38-e360
11 Brendler-Spaeth CI, Jacklin C, See JL, Roseman G, Kalu PU. Autologous breast reconstruction in older women: a retrospective single-centre analysis of complications and uptake of secondary reconstructive procedures. J Plast Reconstr Aesthet Surg 2020;73(05):856-864   DOI
12 Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e326S-e350S   DOI
13 Wilkins EG, Hamill JB, Kim HM, et al. Complications in postmastectomy breast reconstruction: one-year outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study. Ann Surg 2018;267(01):164-170   DOI
14 El-Sabawi B, Sosin M, Carey JN, Nahabedian MY, Patel KM. Breast reconstruction and adjuvant therapy: a systematic review of surgical outcomes. J Surg Oncol 2015;112(05):458-464   DOI
15 Bennett KG, Qi J, Kim HM, Hamill JB, Pusic AL, Wilkins EG. Comparison of 2-year complication rates among common techniques for postmastectomy breast reconstruction. JAMA Surg 2018;153(10):901-908   DOI
16 Calobrace MB, Stevens WG, Capizzi PJ, Cohen R, Godinez T, Beckstrand M. Risk factor analysis for capsular contracture: a 10-year Sientra study using round, smooth, and textured implants for breast augmentation. Plast Reconstr Surg 2018;141(4S Sientra Shaped and Round Cohesive Gel Implants):20S-28S   DOI
17 Pannucci CJ, Chang EY, Wilkins EG. Venous thromboembolic disease in autogenous breast reconstruction. Ann Plast Surg 2009;63(01):34-38   DOI
18 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69(01):7-34   DOI
19 Cemal Y, Albornoz CR, Disa JJ, et al. A paradigm shift in U.S. breast reconstruction: part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg 2013;131(03):320e-326e   DOI
20 Tomaselli GF, Mahaffey KW, Cuker A, et al. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2017;70(24):3042-3067   DOI
21 Pannucci CJ, Dreszer G, Wachtman CF, et al. Postoperative enoxaparin prevents symptomatic venous thromboembolism in high-risk plastic surgery patients. Plast Reconstr Surg 2011;128(05):1093-1103   DOI
22 Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon 2005;51(2-3):70-78   DOI
23 O'Brien T, Fernando A, Thomas K, Van Hemelrijck M, Bailey C, Austin C. Raised preoperative international normalised ratio (INR) identifies patients at high risk of perioperative death after simultaneous renal and cardiac surgery for tumours involving the peridiaphragmatic inferior vena cava and right atrium. BJU Int 2017;119(03):424-429   DOI
24 Douketis JD. Pharmacologic properties of the new oral anticoagulants: a clinician-oriented review with a focus on perioperative management. Curr Pharm Des 2010;16(31):3436-3441   DOI
25 Ricci JA, Epstein S, Momoh AO, Lin SJ, Singhal D, Lee BT. A meta-analysis of implant-based breast reconstruction and timing of adjuvant radiation therapy. J Surg Res 2017;218:108-116   DOI
26 Lemaine V, Schilz SR, Van Houten HK, Zhu L, Habermann EB, Boughey JC. Autologous breast reconstruction versus implant-based reconstruction: how do long-term costs and health care use compare? Plast Reconstr Surg 2020;145(02):303-311   DOI
27 Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL. Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg 2006;118(05):1100-1109   DOI
28 Murphy RX Jr, Alderman A, Gutowski K, et al. Evidence-based practices for thromboembolism prevention: summary of the ASPS Venous Thromboembolism Task Force Report. Plast Reconstr Surg 2012;130(01):168e-175e   DOI
29 Lemaine V, McCarthy C, Kaplan K, et al. Venous thromboembolism following microsurgical breast reconstruction: an objective analysis in 225 consecutive patients using low-molecular-weight heparin prophylaxis. Plast Reconstr Surg 2011;127(04):1399-1406   DOI
30 Keith JN, Chong TW, Davar D, Moore AG, Morris A, Gimbel ML. The timing of preoperative prophylactic low-molecular-weight heparin administration in breast reconstruction. Plast Reconstr Surg 2013;132(02):279-284   DOI