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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(03): 346-351
DOI: 10.1055/s-0042-1744405
Breast/Trunk
Original Article

Postmastectomy Breast Reconstruction is Safe in Patients on Chronic Anticoagulation

Maria Yan 
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
,
Doga Kuruoglu
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
,
Judy C. Boughey
2   Division of Breast Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota
,
Oscar J. Manrique
3   Division of Plastic Surgery, University of Rochester, Rochester, New York
,
Nho V. Tran
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
,
Christin A. Harless
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
,
Jorys Martinez-Jorge
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
,
Minh-Doan T. Nguyen
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
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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

Author Contributions

Conceptualization: M.Y., M.T.N. Data curation: M.Y. Formal analysis: M.Y. Funding acquisition: M.Y. Methodology: M.Y., M.T.N. Project administration: M.Y., M.T.N. Visualization: M.Y., M.T.N. Writing - original draft: M.Y., M.T.N. Writing - review and editing: M.Y., D.K., J.C.B., O.J.M., N.V.T., C.A.H., J.M.-J., M.T.N. All authors read and approved the final manuscript.


Ethical Approval

The study was approved by the Institutional Review Board of Division of Plastic Surgery, Mayo Clinic (IRB No. IRB 19-012716) and performed in accordance with the principles of the Declaration of Helsinki. The informed consent was waived because this study design is a retrospective chart review.


Prior Presentation

This study was presented at Plastic Surgery The Meeting, American Society of Plastic Surgery, October 16–19, 2020.




Publication History

Article published online:
27 May 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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