Symptomatic Pulmonary Thromboembolism following Skin-sparing Mastectomy with Immediate TRAM Reconstruction in Breast Cancer Patients

ABSTRACT

PURPOSE: A skin-sparing mastectomy (SSM) with immediate reconstruction can give psychological and cosmetic benefits to patients requiring a mastectomy, but a risk of pulmonary thromboembolism (PTE) also exists due to longer operative time. The purpose of this study was to evaluate the clinical characteristics of symptomatic PTE following a SSM with immediate reconstruction. METHODS: Of 216 breast cancer patients underwent a SSM with immediate reconstruction at the Asan Medical Center, between December 2003 and July 2005, 7 in whom postoperative symptomatic PTE developed were included in this study. The ventilation/perfusion scan, embolism CT and serum D-dimer level were checked for those suspected of PTE. RESULTS: The prevalence of symptomatic PTE was 3.2% (7/216). Mean patient age and BMI were 41 years and 24.9 kg/m2, respectively. All patients had undergone TRAM reconstruction, with mean operative time of 562.1 minutes. Postoperative bleeding developed in 4 cases. The pathological stages included 0, I and IIA, which were observed in 1, 4 and 2 cases, respectively. Most common symptom of PTE was dyspnea, which developed in all patients on the second or third postoperative day; followed by chest discomfort and tachypnea. The ventilation/perfusion scans showed 6 with high probabilities. All seven patients were diagnosed as PTE on embolism CT. One patient had DVT on the lower extremities. The most common site of PTE was the superior lobar artery and the segmental branches of the right pulmonary artery. All patients recovered, or were recovering, after the LMWH and warfarin treatment. CONCLUSION: This study has shown that SSM with immediate reconstruction possesses a considerable risk of postoperative PTE. Further study on preoperative prophylaxis and the risk factors is warranted to prevent PTE.