Reoperation for haematoma after breast reduction with preoperative administration of low-molecular-weight heparin: Experience in 720 patients

Lapid, Oren; Pietersen, Lars; Horst, Chantal M.A.M. van der

doi:10.1016/j.bjps.2012.05.027

Cited by 15 publications

(4 citation statements)

References 26 publications

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“…We observed a reoperation rate of 4.6% for postoperative hematoma. This is similar to the percentage found in our institution for breast reduction in females (13). Due to the retrospective nature of this study, we did not focus on minor complications and adverse events.…”

Section: Discussionsupporting

confidence: 91%

Surgical management of gynecomastia: 20 years’ experience

Lapid

Jolink

2013

Scand J Surg

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Section: Discussionsupporting

confidence: 91%

Surgical management of gynecomastia: 20 years’ experience

Lapid

Jolink

2013

Scand J Surg

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“…9,10 The clear downside of venous thromboembolism chemoprophylaxis has been the risk of bleeding, but this has been shown to be an acceptable risk in general surgery (<3 percent) 11 and plastic surgery patients, 3,12 further underscoring the importance of venous thromboembolism chemoprophylaxis. Cancer may activate the prothrombotic environment and place patients at greater risk for venous thromboembolic events.…”

Section: Discussionmentioning

confidence: 96%

Venous Thromboembolism Risk in Mastectomy and Immediate Breast Reconstruction

Fischer

Wes

Tuggle

et al. 2014

Plastic and Reconstructive Surgery

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“…A study by Lapid et al [22] recently showed that the use of preoperative LMWH is associated with a higher incidence of reoperations for haematoma in breast reduction patients. However, breast reconstruction with perforator free flaps is a more complex operation, where operation time usually exceeds 3 hours and, therefore, increases the risk of deep venous thrombosis and pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

Breast free flap complications related to haematoma formation – do the risks of multiple antithrombotics outweigh the benefits today?

Halle

Skogh

Friberg

et al. 2016

Journal of Plastic Surgery and Hand Surgery

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Background Free flap reconstruction is today a common operation for many breast cancer patients, but local protocols for microsurgery still predict the use of antithrombotic agents. Reduced operation times and complication rates together with faster mobilisation, after introduction of perforator flaps, call for less comprehensive antithrombotic regimens. It was hypothesised that multiple antithrombotics was a risk factor for bleeding-related flap complications. Methods A retrospective cohort study was conducted to study the association between reoperation for haematoma and flap-related complications after free flap breast reconstruction. A combination of heparin, low-molecular-weight heparin and dextran were used as antithrombotics. A sub-analysis was performed to compare non-dextran to dextran treated patients. Results One hundred and thirty-nine patients were identified, reconstructed with 150 consecutive perforator free flaps to the breast. Reoperation for breast haematoma (13%) was associated with concomitant re-operation for venous congestion (8.6%) (p < 0.001), but also for flap thrombosis (2.9%) (p = 0.007), highlighting haematoma as a risk factor for flap-related complications. An increased rate of haematoma re-operations of the breast was noted among the flap-related complications in the dextran (n = 79), compared to the non-dextran group (p = 0.011). Conclusion The current study highlights the use of multiple antithrombotics as a risk factor for haematoma reoperation. Liberal use of drains and evacuation of breast haematomas are, therefore, indicated together with limitation of antithrombotic agents. The highly variable use of antithrombotic agents worldwide call for evidence-based guidelines in standardised free flap breast reconstruction.

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Reoperation for haematoma after breast reduction with preoperative administration of low-molecular-weight heparin: Experience in 720 patients

Cited by 15 publications

References 26 publications

Surgical management of gynecomastia: 20 years’ experience

Surgical management of gynecomastia: 20 years’ experience

Venous Thromboembolism Risk in Mastectomy and Immediate Breast Reconstruction

Breast free flap complications related to haematoma formation – do the risks of multiple antithrombotics outweigh the benefits today?

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