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Safety of Hormonal Therapy prior to DIEP Reconstruction: A Matched Cohort Analysis
Viren Patel, Shannon Wu, Rachel Schafer, Priya Shukla, Anthony Deleonibus, Sarah Bishop, Raffi Gurrunian, Stephen Bernard, Risal Djohan, Graham Schwarz
Cleveland Clinic
2024-02-01
Presenter: Viren Patel
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Raymond Isakov
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: Hormone therapy (HT) has become a mainstay in the treatment of receptor positive breast cancers. There have been conflicting reports regarding the effects of hormonal therapy after autogenous breast reconstruction (ABR), with some reports suggesting patients on HT have a higher risk of complication and flap failure, while other studies bolstering the peri-operative safety of. Here, we present a matched cohort analysis to determine if hormonal therapy affects outcomes following ABR.
Method: A retrospective review was conducted of patients undergoing ABR between 2016-2020. Patients were split into two cohorts: those on hormonal therapy (HT), and those not on hormonal therapy (NH) based on a 1:1 propensity match, based on variables known to be risk factors for complications following DIEP including BMI, smoking, history of radiation and diabetes.
Results: 108 patients were matched into the HT and NH cohorts. Overall, patients in the HT cohort were significantly more likely to develop a complication (HT: 44 (41%) vs NH: 25 patients (23%); p=0.006). Incidence of intraoperative thrombosis was similar between the cohorts as was incidence of post-operative total flap loss. HT did have a significantly increased risk of venous thromboembolism (VTE) when compared to NH patients (HT: 3.7 % vs NH 0%; p=0.04).
Conclusion: This is the first study examining the effect of pre-operative hormonal therapy on ABR, with matched cohorts to control for comorbidities. HT patients had a significantly higher risk of complication and VTE, suggesting patients should discontinue hormonal therapy prior to surgery.
