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Anticancer Agents and Their Impact on Breast Reconstruction: A Guide for Plastic Surgeons Based on Systematic Review
Emily E Zona1, Sarah M Thornton1, Ellen C Via1
1From the Division of Plastic Surgery.
Background:
Adjuvant anticancer agents are often prescribed to patients with breast cancer to reduce recurrence risk and improve outcomes. Many patients take these medications during primary and staged breast reconstruction. This study presents a review of the literature on adjuvant anticancer medications and whether, based on side effects and risks, they should be held for elective, medically necessary reconstructive procedures. The authors provide expert multidisciplinary consensus recommendations for commonly prescribed agents.
Methods:
Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the authors queried 3 databases for relevant key words (eg, "breast reconstruction" AND "anticancer agent"). Inclusion criteria encompassed studies on anticancer agents and breast reconstruction; non-English-language articles and reviews were excluded. Perioperative recommendations were developed on the basis of the review and expert consensus.
Results:
The query identified 1188 articles, which was narrowed to 19 included articles involving 5793 patients. Included studies discussed tamoxifen ( n = 18), aromatase inhibitors ( n = 8), trastuzumab ( n = 2), or pertuzumab ( n = 1). No study examined gonadotropin-releasing hormone agonists or pembrolizumab. Based on the review and consensus, the authors created guidelines on when to hold medications preoperatively. Expert consensus indicated that most medications do not need to be held, although preoperative laboratory tests evaluating leukocytes or platelets are advised in some cases.
Conclusions:
Plastic surgeons frequently treat patients who are taking anticancer agents. Rapid research advancements present challenges to understanding the impact of anticancer agents on perioperative risk and surgical outcomes. The guidelines in this article provide an update on medication management and perioperative counseling for patients undergoing primary or revision breast reconstruction procedures.
