Impact of adjuvant anti-estrogen therapies (tamoxifen and aromatase inhibitors) on perioperative outcomes of breast reconstruction

Abstract

Hormone (anti-estrogen) therapy (HT) plays a major role in hormone receptor-positive breast cancer management. The latest guidelines propose to extend the duration of adjuvant treatment from 5 to 10 years. The association between HT and thromboembolic or microvascular complications during breast reconstruction has been investigated. However, while estrogens play a crucial role in wound healing, no study has assessed the impact of tamoxifen or aromatase inhibitors on other postoperative complications, including wound healing complications. This study aimed to assess the impact of HT on surgical outcomes after breast reconstruction. All patients who underwent breast reconstruction between January 2012 and December 2013 were reviewed. Rates of wound healing complications, prosthesis complications, microvascular thrombosis, flap failures, and venous thromboembolism were retrospectively compared between patients treated and not treated with HT at the time of surgery. A total of 233 operations were performed: 78 free flaps, 12 autologous latissimus dorsi flaps, 47 implants, 42 lipofilling, and 54 secondary symmetrization. At the time of surgery, 38% of patients were treated with HT. Those who received HT experienced significantly more wound healing complications (61% versus 28%; p<0.001), including fat necrosis (26% versus 8.3%; p<0.001), infections (15% versus 2.8%; p<0.001), delayed wound healing (49% versus 13%; p<0.001), and grade III/IV capsular contracture (55% versus 9.1%; p=0.001). No significant difference was observed in the occurrence of microvascular thrombosis and venous thromboembolism. HT seems to be associated with an increased risk of wound healing complications. Currently, there is no guideline on perioperative HT discontinuation. Further investigations are required.