Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Germany.
Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Germany.
J Plast Reconstr Aesthet Surg. 2023 Oct;85:143-148. doi: 10.1016/j.bjps.2023.07.004. Epub 2023 Jul 5.
Hormone therapy with selective estrogen modulators (tamoxifen) and aromatase inhibitors is commonly used in the treatment of breast cancer. While the increased risk for thromboembolic events has been known since their early application, the potential risk in microsurgical breast reconstruction is still debated. This study aimed to evaluate the risk for microvascular flap complications in patients with perioperative hormone therapy.
All patients who underwent microsurgical breast reconstruction with a deep inferior epigastric perforator (DIEP) or transverse myocutaneous gracilis flap at our institution between March 2010 and November 2020 were retrospectively identified in our records. Patients were grouped according to the type and use of perioperative hormone therapy. Flap-related thromboembolic events, flap loss, and revision procedures were compared and analyzed between groups. Risk factors associated with postoperative microsurgical complications were determined.
A total of 560 patients (656 flaps) were included in our analysis. One hundred ninety-eight patients (224 flaps) received perioperative hormone therapy (35.4%) and 50 (8.9%) postoperative microsurgical events occurred. Tamoxifen and aromatase inhibitors were not associated with postoperative microsurgical events (p = 0.254), full flap loss (p = 0.702), or partial flap loss (p = 0.916). Patients receiving DIEP flaps had a higher risk for postoperative microsurgical complications (OR 2.36, p = 0.004) and partial flap loss (OR 14.66, p < 0.001). A BMI > 30 was associated with an increased risk for partial flap loss (OR 4.2; p < 0.001) CONCLUSION: This article presents one of the largest single-center datasets for the risks of hormone therapy in microsurgical breast reconstruction. Our results show that perioperative hormone therapy does not increase the risk for microsurgical complications. The findings of our study do challenge the common practice of discontinued hormone therapy before microsurgical breast reconstruction.
选择性雌激素调节剂（他莫昔芬）和芳香酶抑制剂的激素治疗常用于乳腺癌的治疗。尽管自早期应用以来就已经知道其增加血栓栓塞事件的风险，但在显微乳房重建中潜在的风险仍存在争议。本研究旨在评估围手术期激素治疗患者中微血管皮瓣并发症的风险。
我们在病历中回顾性地确定了 2010 年 3 月至 2020 年 11 月期间在我们机构接受深部下腹壁穿支皮瓣（DIEP）或横形肌皮瓣显微乳房重建的所有患者。根据围手术期激素治疗的类型和使用，将患者分为两组。比较并分析了各组之间与皮瓣相关的血栓栓塞事件、皮瓣丢失和修正手术。确定与术后显微手术并发症相关的危险因素。
共纳入 560 例患者（656 个皮瓣）。198 例患者（224 个皮瓣）接受围手术期激素治疗（35.4%），50 例（8.9%）发生术后显微手术并发症。他莫昔芬和芳香酶抑制剂与术后显微手术并发症（p=0.254）、全皮瓣丢失（p=0.702）或部分皮瓣丢失（p=0.916）无关。接受 DIEP 皮瓣的患者术后显微手术并发症（OR 2.36，p=0.004）和部分皮瓣丢失（OR 14.66，p<0.001）的风险更高。BMI>30 与部分皮瓣丢失的风险增加相关（OR 4.2；p<0.001）。
本文介绍了在显微乳房重建中激素治疗风险的最大单中心数据集之一。我们的研究结果表明，围手术期激素治疗不会增加显微手术并发症的风险。我们研究的结果确实对在显微乳房重建前停止激素治疗的常规做法提出了挑战。
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