Effects of Hormone Therapy on Perioperative Outcomes of Abdominal Based Perforator Free Flap
Bao Ngoc N. Tran, MD, Qing Z. Ruan, MD, Justin B. Cohen, MD, MHS Parisa Kamali, MD, Andres Doval, MD, Dhruv Singhal, MD, Samuel J. Lin, MD, Bernard T. Lee, MD, MPH, MBA, FACS
Department of Surgery, Division of Plastic and Reconstructive Surgery Beth Israel Deaconess Medical Center, Harvard Medical School
Background: The use of hormone therapy, specifically Tamoxifen, has been proposed to increase thromboembolic events (VTE). This phenomenon is detrimental in abdominal based perforator free flap breast reconstruction. Our study aims to examine this hypothesis using our institutional database.
Methods: A retrospective review of a single-institution database was performed on all patients undergoing abdominal based perforator free flap reconstruction between 2004-2015. Patients were divided into control group and hormone therapy group. Rates of complications were compared between two groups using chi-square test. A logistic regression model was used to identify risk factors associated with complete and partial flap loss and overall complications.
Results: There were 1253 flaps, corresponding to 853 patients. A total of 193 patients (22.6%) were on hormone therapy at the time of surgery, 660 (77.4%) were not. Those who received hormone therapy had higher incidence of previous breast surgery, advanced cancer stage, chemoradiation prior to reconstruction, delayed and unilateral reconstruction, and heavier flaps. There were no statically significant differences in complete flap loss (1.0% vs. 1.1%) and partial flap loss (2.2% vs. 1.5%) rate between control and hormonal group. Hypertension and previous breast surgery were the only independent risk factors for minor complications, and overall complications.
Conclusions: Hormone therapy, specifically Tamoxifen, was not associated with higher incidence of postoperative partial or complete flap loss or overall complications. We propose an individualized approach to preoperative cessation of Tamoxifen in which each patient's risk factor profile is examined thoroughly prior to decision to hold therapy.
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