Immediate breast reconstruction following mastectomy is becoming more prevalent, but for breast cancer patients undergoing simultaneous chemotherapy, thrombotic complications can delay or significantly modify reconstructive plans, finds a study in the Annals of Medicine and Surgery.
“With multidisciplinary cooperation among surgeons, oncologists, and hematologists, the surgical management plan for these patients can remain largely unaffected. Reconstructive surgeons should, however, be flexible enough to alter their surgical plan in patients who develop line-related thrombosis.” —Professor Charles M. Malata, FRCS (Plast)
Chemotherapy delivered via the placement of a central venous line that remains in place for the duration of treatment can result in preoperative thromboembolic events, which can require the administration of anticoagulation agents. This in turn can complicate subsequent surgery and is particularly significant when complex reconstruction is anticipated immediately following the mastectomy.
“There is limited research on the impact of this complication on breast reconstruction pathways and guidance for optimal management of these patients,” says Professor Charles M. Malata, FRCS (Plast), consultant plastic & reconstructive surgeon at the Cambridge Breast Unit (Cambridge University Hospitals NHS Foundation Trust) and professor of academic plastic surgery at the Postgraduate Medical Institute of Anglia Ruskin University.
Malata and colleagues analyzed the pathways of seven breast cancer patients who had received primary chemotherapy during which they experienced preoperative line-related thrombosis requiring anticoagulation. Five were able to undergo surgeries as planned. Two patients had their breast reconstruction plans stalled.
For one, surgery was delayed for 3 weeks while the thrombosis was managed, followed by two separate surgeries over a 12-month period to complete reconstruction. In the second case, the reconstruction was achieved as planned after a 3-month delay and required anticoagulation therapy and preoperative radiotherapy.
“As these cases demonstrate, line-associated thrombosis will be increasingly encountered by surgeons as more patients receive neoadjuvant chemotherapy and are managed by indwelling venous access devices,” Malata says in a news release. “With multidisciplinary cooperation among surgeons, oncologists, and hematologists, the surgical management plan for these patients can remain largely unaffected. Reconstructive surgeons should, however, be flexible enough to alter their surgical plan in patients who develop line-related thrombosis.”