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

  • Raphaëlle Billon
    Affiliations
    Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri Mondor University Hospital, UPEC, University Paris-Est Créteil, Créteil, France
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  • Romain Bosc
    Correspondence
    Corresponding author. Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri Mondor University Hospital, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France. Fax: +33 01 49 81 25 32.
    Affiliations
    Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri Mondor University Hospital, UPEC, University Paris-Est Créteil, Créteil, France

    Centre Sein Henri Mondor, Henri Mondor University Hospital, Créteil, France
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  • Yazid Belkacemi
    Affiliations
    Centre Sein Henri Mondor, Henri Mondor University Hospital, Créteil, France

    Department of Radiation Therapy and Oncology, Henri Mondor University Hospital, UPEC, University Paris-Est Créteil, INSERM U 955 Eq07, Créteil, France
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  • Elias Assaf
    Affiliations
    Centre Sein Henri Mondor, Henri Mondor University Hospital, Créteil, France

    Department of Oncology, Henri Mondor University Hospital, UPEC, University Paris-Est Créteil, Créteil, France
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  • Mounia SidAhmed-Mezi
    Affiliations
    Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri Mondor University Hospital, UPEC, University Paris-Est Créteil, Créteil, France
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  • Barbara Hersant
    Affiliations
    Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri Mondor University Hospital, UPEC, University Paris-Est Créteil, Créteil, France
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  • Jean-Paul Meningaud
    Affiliations
    Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri Mondor University Hospital, UPEC, University Paris-Est Créteil, Créteil, France
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      Summary

      Purpose

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Keywords

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