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Adjunctive Cancer Therapeutics in Breast Reconstruction: A Comprehensive Guide for Perioperative Medication Hold Times
Nicholas Vernice*
1, Alexis C. Lakatta
1, Thomas J. Sorenson
1, Carter Boyd
1, Kshipra Hemal
1, Oriana Cohen
1, Mihye Choi
1, Nolan S. Karp
1
1. Plastic Surgery, NYU, New York, NY, United States.
Background: Neoadjuvant and adjuvant systemic therapies are increasingly used in breast cancer care, yet their perioperative implications for breast reconstruction remain poorly defined. Existing literature largely focuses on oncologic resection, with limited guidance for reconstructive surgery. This study aims to provide an evidence-based framework for perioperative management and recommended hold times for adjunctive cancer therapeutics.
Methods: An evidence-based literature review was conducted using Open Evidence to identify studies evaluating perioperative risks associated with breast cancer therapeutics. Outcomes of interest included infection, bleeding, thrombosis, and impaired wound healing. Medications were stratified into low-, moderate-, and high-risk categories based on reported complications, statistical significance, and FDA labeling. Published recommendations and pharmacologic data were used to inform perioperative hold strategies.
Results: Twenty-seven medications were included. Most available data were derived from oncologic surgery rather than reconstruction-specific cohorts. Hematologic toxicity was the most frequently reported adverse effect, while wound healing complications were inconsistently described. Most agents were classified as low to moderate risk. Four medications were identified as high risk, most associated with thromboembolic or bleeding events. Formal perioperative guidelines were limited; however, laboratory optimization and multidisciplinary coordination were consistently emphasized. Suggested hold times varied but were generally guided by drug half-life and recovery of hematologic parameters.
Conclusions: Most adjunctive cancer therapeutics can be safely managed in the perioperative setting with appropriate risk stratification and monitoring. High-risk agents may require temporary discontinuation, while many others can be continued or briefly held. This framework provides a practical reference for perioperative decision-making and highlights the need for standardized, reconstruction-specific guidelines.
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