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Perioperative use of anti-estrogen therapies in breast reconstruction: A systematic review and treatment recommendations
Leigh Spera MD, Julia Cook MD, Mary Lester MD, Aladdin Hassanein MD MSC
Indiana University division of plastic surgery
2018-02-15
Presenter: Leigh Spera
Affidavit:
This paper was conceptualized, researched, and written by the designated authors.
Director Name: William Wooden
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction: Patients with hormone receptor positive breast tumors receive hormonal therapy using selective estrogen receptor modulators (SERM) (e.g. tamoxifen) or aromatase inhibitors (AI) (e.g. anastrozole) for 5 years. Patients are frequently prescribed these while undergoing breast reconstruction. Literature investigating the effects of hormonal modulators on breast reconstruction outcomes demonstrates conflicting results. The purpose of this study is to perform a systemic review to assess the effects of hormonal therapy on breast reconstruction outcomes and guide perioperative management of anti-estrogen therapies.
Methods: A MEDLINE search of articles regarding the effects of SERMs and AIs on breast reconstruction was performed. Outcomes of interest included wound complications, flap loss, and thromboembolic events. Included studies were assigned methodological index for nonrandomized studies (MINORS) quality scores.
Results: 2581 flaps were evaluated for complete loss: patients taking SERMs at the time of reconstruction had a higher rate of flap loss compared to patients not taking them (p<0.001) but AIs had no effect (p=0.11). Wound complications were evaluated in 1885 flaps: AIs were significantly associated with delayed wound healing (p=0.04) when compared to patients not taking hormone modulators, but SERMs had no effect (p=0.50). Incidence of DVT was evaluated in 931 patients undergoing microsurgical breast reconstruction: 1.2% on tamoxifen developed postoperative DVTs.
Conclusions Patients taking SERMs at the time of operation are at increased risk of flap loss and those taking AIs are at an increased risk of wound complications. These findings support holding these medications for 1-2 half-lives (SERMs 14-28 days, AIs 2-4 days) preoperatively.
