Tamoxifen Increases the Risk of Microvascular Flap Complications in Patients Undergoing Microvascular Breast Reconstruction

Abstract

Tamoxifen citrate (tamoxifen) has been associated with increased rates of thromboembolic events, prompting concerns that it may increase the risk of complications after microvascular breast reconstruction. Some centers have implemented protocols to temporarily stop tamoxifen before microvascular breast reconstruction. The authors sought to determine whether this practice is warranted. A total of 670 patients underwent delayed microsurgical breast reconstruction at the authors' institution between January of 2000 and April of 2010. Rates of microvascular flap complications and pulmonary emboli were retrospectively compared between patients who were and were not receiving tamoxifen at the time of reconstruction. A total of 205 patients received tamoxifen within 28 days before reconstruction (these patients were considered to be receiving tamoxifen at reconstruction); 465 patients did not. Those who received tamoxifen were significantly younger (p < 0.0001) and thinner (p = 0.0025), with less cardiovascular morbidity (p = 0.04) and shorter durations of operations (p = 0.05). Despite fewer comorbidities, microvascular flap complications were significantly more common among tamoxifen patients (21.5 versus 15 percent; p = 0.04). They had 1.7 times the risk of complications (p = 0.015) and 1.8 times the risk of follow-up complications (p = 0.03) than no-tamoxifen patients. In the tamoxifen group, cardiovascular comorbidities significantly increased the risk of flap complications (p = 0.002). Tamoxifen patients had a significantly increased rate of immediate total flap loss (p = 0.041) and a lower rate of flap salvage (p = 0.023). Tamoxifen did not appear to increase the risk of pulmonary embolus during or after delayed microvascular breast reconstruction. Tamoxifen may increase the risk of microvascular flap complications. Surgeons should consider temporarily stopping the drug 28 days before microsurgical breast reconstruction. Risk, II.