title: The Effects of Perioperative Tamoxifen Therapy on Microvascular Flap Complications in Transverse Rectus Abdominis Myocutaneous/Deep Inferior Epigastric Perforator Flap Breast Reconstruction.
abstract: BACKGROUND
  Tamoxifen is an important adjunct therapy in breast cancer treatment; however, it has been implicated in increasing microvascular flap complications. Current recommendations on stopping tamoxifen are conflicting and do not address tamoxifen therapy that is continued perioperatively. The purpose of this study is to determine whether tamoxifen taken at the time of free transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric perforator (DIEP) flap breast reconstruction affects thrombotic complication rates.
  
  
  METHODS
  A retrospective review of microvascular breast reconstruction with TRAM/DIEP flaps over the last 20 years was carried out at a single institution. Patients were divided into 2 cohorts: those receiving tamoxifen at the time of reconstruction (tamoxifen cohort) and those not taking tamoxifen (control). Demographic information, procedural characteristics, and rates of microvascular flap complications were compared.
  
  
  RESULTS
  Forty-three patients (56 flaps) received tamoxifen at the time of microvascular breast reconstruction, and 185 patients (267 flaps) did not. Patients in the tamoxifen cohort had a lower mean age of 48.9 years (P = 0.013). A greater percentage of patients in the tamoxifen cohort had preoperative radiation (P < 0.0001) and chemotherapy (P = 0.018) and underwent delayed reconstruction (P < 0.0001). There were no significant differences between the 2 cohorts with regard to flap complications including both arterial and venous thrombosis, flap failure, and other local flap complications.
  
  
  CONCLUSIONS
  Patients receiving tamoxifen during TRAM/DIEP flap breast reconstruction did not have increased rates of flap thrombosis or failure; therefore, stopping tamoxifen prior to these procedures may not be necessary.
authors.affiliation: From the Department of Plastic Surgery, University of California, Irvine, Orange, CA.
authors.forename: Ara A
authors.initials: AA
authors.lastname: Salibian
authors.forename: Andrew V
authors.initials: AV
authors.lastname: Bokarius
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gu
authors.forename: Yoon
authors.initials: Y
authors.lastname: Lee
authors.forename: Garrett A
authors.initials: GA
authors.lastname: Wirth
authors.forename: Keyianoosh Z
authors.initials: KZ
authors.lastname: Paydar
authors.forename: Mark R
authors.initials: MR
authors.lastname: Kobayashi
authors.forename: Gregory R D
authors.initials: GR
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D019074:Epigastric Arteries / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation; D061525:Perforator Flap / Q000098:blood supply / Q000637:transplantation; D011183:Postoperative Complications / Q000139:chemically induced*; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation; D012189:Retrospective Studies; D013629:Tamoxifen / Q000009:adverse effects* / Q000627:therapeutic use; D013927:Thrombosis / Q000139:chemically induced* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen