Postmenopausal Hormone Replacement Therapy is not Associated with Increased Postoperative Complications After Breast...

Breast surgery and reconstruction rates in the USA continue to rise, with over 90% of new breast cancer diagnoses occurring in peri- or postmenopausal women. Despite the relevance of menopause to wound healing, postoperative outcomes in this population remain understudied. Estrogen hormone replacement therapy (HRT) may aid wound healing and menopausal symptoms, but carries prothrombotic risk. We investigate postsurgical outcomes after breast surgery and reconstruction among postmenopausal patients on HRTs compared to those without HRT use.

Using the TriNetX database, we compared patients with and without HRT use within 1 year preceding breast reconstruction. Mastectomy and reconstruction procedures were identified using CPT codes. HRT use was identified using ICD-10 and RxNorm codes. Cohorts were propensity-matched for demographics and comorbidities. Risk differences with 95% confidence intervals were calculated for outcomes within 90 days postoperatively. Analyses were performed within TriNetX, with significance set at P < 0.05.

Two cohorts were generated, with 3750 HRT+ and 75503 HRT- patients. After propensity matching, two cohorts of 3750 patients each were created. After propensity adjustment, there was no significant association between HRT use and postoperative mortality, VTE, or wound healing complications, which were comparably low across all surgery types. Among patients undergoing autologous reconstruction, 1-year revision rates were higher in the HRT+ cohort.

Systemic hormone replacement therapy was not associated with an increased complications after breast reconstruction, including mortality, thrombosis, infection, and wound dehiscence. Further prospective studies across surgical populations are needed to validate these findings.