Northeastern Society of Plastic Surgeons

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Do Disease-Modifying Anti-Rheumatic Drugs Affect Implant Breast Reconstruction Outcomes?
Ethan Fung*, Jacquelyn Roth, Diana Shaari, Bernice Yu, Peter J. Taub
Plastic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

Background: As breast implants increase in popularity, there remains concern over implant safety. Currently, close to 8% of the U.S population lives with an autoimmune disease, yet there is a paucity of literature on whether these patients taking disease-modifying anti-rheumatic drugs (DMARDs) have worse outcomes in implant-based breast reconstruction.
Methods: The TriNetX database was employed to identify 2 cohorts of patients: those with an autoimmune connective tissue disease who were on a DMARD, who underwent either tissue expander placement, delayed implant placement, or immediate implant placement and those with similar diagnoses undergoing the same procedure, without prior exposure to DMARDs. Demographics and comorbidities were gathered and matched via a 1:1 propensity-scored analysis. Postoperative outcomes were analyzed via logistic regression to identify predictors of 90-day and 2-year outcomes.
Results: 1,262 patients were identified for each cohort. Within 90 days, DMARD patients had higher odds of necrosis (OR 1.86, P = 0.03) and surgical site pain (OR 1.43, P = 0.01). Within 2 years, DMARD patients had higher odds of postoperative infection (OR 1.35, P = 0.04), DVT (OR 1.76, P = 0.01), PE (OR 2.52, P = 0.001), emergency room (ER) visit (OR 1.21, P = 0.03), surgical site pain (OR 1.46, P = 0.001), and any breast complication (OR 1.22, P = 0.03). In a subgroup analysis, patients on DMARDs were further divided into conventional DMARDs, biologic DMARDs, and JAK inhibitors. Patients on conventional DMARDs were found to have increased odds of capsular contracture within 2 years compared to patients on biologic DMARDs (OR 3.29, P = 0.001). When conventional DMARDs were compared to JAK inhibitors, there were no significant 2-year outcomes.
Conclusion: Patients on DMARDs were more likely to experience negative postoperative outcomes within 90 days and 2 years, with slight differences in DMARD subtypes. Plastic surgeons should be cognizant of these possible complications when treating autoimmune patients taking these medications.
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