Yan Maria, Kuruoglu Doga, Boughey Judy C, Manrique Oscar J, Tran Nho V, Harless Christin A, Martinez-Jorge Jorys, Nguyen Minh-Doan T
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Breast Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota.
Arch Plast Surg. 2022 May 27;49(3):346-351. doi: 10.1055/s-0042-1744405. eCollection 2022 May.
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. 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. 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/m (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%, = 0.005). There were no differences regarding incidence of hematoma (2.7% vs. 1.4%, = 0.63), thromboembolism (5% vs. 0%, = 0.16), reconstructive-related complications, or length of hospitalization (1.6 days [SD = 24.2] vs. 1.4 days [SD = 24.2], = 0.85). 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.
乳房切除术后乳房重建（PMR）可提高患者满意度、生活质量和心理社会幸福感。关于慢性抗凝患者进行PMR安全性的数据很少。围手术期并发症会降低患者满意度；因此，阐明此类患者进行PMR的安全性很重要。
我们机构对接受植入物乳房重建且长期抗凝的患者进行了一项回顾性病例对照研究。纳入标准为年龄≥18岁的女性。排除标准包括自体组织重建、保乳手术和肿瘤整形手术。每例抗凝患者匹配两名对照，对照在年龄、体重指数、放疗史、吸烟史、重建类型、重建时间和患侧等方面与病例组相匹配。
2009年至2020年期间，37例乳房（20例患者）接受了基于植入物的乳房重建并长期抗凝。共有74例乳房（40例患者）具有与病例组相似的人口统计学特征，被定义为对照组。病例组的平均年龄为53.6岁（标准差[SD]=16.1），平均体重指数为28.6kg/m²（SD=5.1），2.7%的乳房在重建前接受过放疗，5.4%在重建后接受过放疗。9例患者使用华法林长期抗凝，6例使用阿哌沙班，3例使用利伐沙班，1例使用低分子肝素，1例使用达比加群。抗凝的指征在50%的患者中是既往有血栓栓塞事件。抗凝患者发生包膜挛缩的风险更高（10.8%比0%，P=0.005）。在血肿发生率（2.7%比1.4%，P=0.63）、血栓栓塞（5%比0%，P=0.16）、与重建相关的并发症或住院时间方面（1.6天[SD=24.2]比1.4天[SD=24.2]，P=0.85）没有差异。
对于长期抗凝的患者，通过适当的围手术期抗凝管理，乳房切除术后基于植入物的乳房重建可以安全进行。这些信息对于此类患者的术前咨询可能有用。
