I like to read my journals. The Feb 2012 issue of Plastic and Reconstructive Surgery Journal had an article “Tamoixfen Increases the Risk of Microvascular Flap Complications in Patients Undergoing Microvascular Breast Reconstruction.” Long title. In English:
- Tamoxifen is an anti-estrogen drug.
- It is very common to prescribe after breast cancer diagnosis, focusing on those with estrogen positive tumors (an anti-estrogen will help keep the tumor from coming back)
- Tamoxifen has been associated with increased rates of thromboemboic (clotting) events
- Some centers have temporarily been stopping tamoxifen before microvascular breast reconstructions.
The question: Should they? Should they be stopping Tamoxifen? Is Tamoxifen associated with higher complication rates?
So, the study out of Houston. They looked at 670 patients who underwent delayed reconstruction (immediate recon would not be on Tamoxifen yet). Rates of microvascular flap (TRAM is the most common) complications and pulmonary emboli rates were looked at.
Results:
- 205 of the 670 patients had Tamoxifen within 28 days of surgery
- The Tamoxifen group tended to be significantly younger, thinner, and less cardiac morbidity
- Despite being younger, thinner, and healthier (which one would think would reduce complications) the Tamoxifen group had 1.7 times the risk of complications.
- There was no difference in the rate of pulmonary emboli (Though other studies have shown increased risk of DVT/PE of 1.3-7x).
They conclude Tamoxifen should be stopped 28 days prior to surgery. I found this article interesting, in that it dovetails some of the theories in another paper which I blogged about recently which discussed how postmenopausal women have higher breast reduction complications. Is estrogen some kind of magic healing hormone? We can’t blindly take lots of estrogen due to its association with making estrogen responsive breast tumors grow faster. But we are starting to evaluate estrogen. It is thought estrogen receptors on the vascular endothelium (lining of arteries and veins) increase blood flow.
They concluded their article by stating it is unclear how long you need to be off Tamoxifen before surgery.