Venous Thromboembolic Disease in Autogenous Breast Reconstruction

Abstract

Venous thromboembolic disease (VTE) is a cause of significant morbidity and mortality in patients with cancer. Large studies have estimated that VTE occurs in up to 1.1% of patients undergoing breast cancer tumor extirpation and in up to 1.5% of patients undergoing breast cancer reconstruction. This study sought to retrospectively review the experience of a large university practice with TRAM, DIEP, and latissimus flap reconstruction for mastectomy defects and evaluate our rate of VTE. In our series of 271 consecutive patients, 2 had deep venous thromboses, 2 had both deep venous thromboses and pulmonary emboli, and 2 had pulmonary embolus alone. VTE incidence was 2.2%, a relatively high rate compared with previously published, large population studies of VTE in breast reconstruction patients. Review of the literature suggests that physicians have poor compliance with established guidelines for prophylaxis and treatment of VTE in general and orthopedic surgery populations. Unfortunately, no specific guidelines are available for patients undergoing operative intervention for breast cancer or autogenous tissue based reconstruction. VTE is significantly under-diagnosed: clinical findings alone are unreliable, and the true prevalence may be greater than twice what is reported. Further research is needed in this largely unexplored field to determine appropriate means of VTE prophylaxis and treatment in the breast cancer population.