Post-Breast Reconstruction Surgery and Opioid Use

A study published in the December issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons, says that 10 percent of women who undergo mastectomy and immediate breast reconstruction depend on opioid pain relievers months after surgery.

Opioids are a class of pain relievers that include oxycontin, hydrocodone, codeine, fentanyl and morphine.

The research, performed by the University of Michigan, Ann Arbor, analyzed health information collected from 4,113 women who experienced a mastectomy and immediate breast reconstruction between 2010 and 2014.

According to the American Society of Plastic Surgeons, breast reconstruction is the most common type of cancer reconstruction procedure in the U.S., with 109,000 procedures performed in 2016.

"Many women choose the breast reconstruction procedure after mastectomy because they want to feel 'whole' after losing one or both breasts," said Dr. Mona Alqulali, F.A.C.O.G., Ph.D.

During the breast reconstruction procedure, a plastic surgeon replaces the breast tissue removed during a mastectomy or lumpectomy with a saline or silicone breast implant or tissue from another body area such as the abdomen or back of the thigh.

Some reconstruction procedures combine both artificial implants and patient tissue.

Identifying At-Risk Groups

Researchers deemed the women who participated in the study as "opioid-naive" with prescriptions for opioids in the year before their surgeries.

Pharmacy records of the participants showed that 90 percent of the women filled their opioid pain reliever prescriptions after their breast reconstruction procedures.

The findings regarding the opioid prescriptions were similar to other studies that reported on high rates of opioid use after less serious surgical procedures.

Three months post-op, 10 percent of the women in the study continued to fill their opioid prescriptions.

Women who experienced complications from their surgical procedure such as infection filled their prescriptions more readily than their counterparts without complications.

Continued opioid use was less likely for participants who were undergoing chemotherapy or those who opted for natural breast augmentation using autologous tissue compared to women who chose artificial implant reconstruction.

Women with depression and anxiety also used opioids at higher rates, as did women who experienced bilateral reconstruction or reconstruction of both breasts.

Women between 55 and 64 used opioids at lower doses than younger demographics.

"Using pain relievers is a common way to manage pain after surgery, but if the use of opioids continues for months after the procedure, patients should talk to their physicians to find different ways to manage pain," Alqulali said.

The recovery from breast reconstruction is similar to the recovery for other breast surgery procedures, such as breast augmentation and the breast lift.

"Typically there is bruising and swelling for two to three weeks after surgery, and patients should expect to wear a compression garment after surgery to reduce fluid retention," Alqulali said.

Many individuals can return to regular activity six to eight weeks after their procedures and can resume strenuous activity or exercise after being cleared by their physician.

The Impact of Opioids

The primary concern regarding the prolonged use of opioids after surgery is dependence.

Other effects of long-term use include digestive problems such as nausea, vomiting and constipation; abdominal distention; respiratory depression; liver damage; and brain damage.

Prolonged opioid use also makes individuals more tolerant of the drugs.

"If a patient becomes tolerant to a pain reliever, the pain reliever will not work if they need it after another surgery," said Alqulali.

Although these drugs are legal when prescribed by a physician, opioid abuse and addiction is an increasing problem in the U.S.

According to the American Society of Addiction Medicine, there were 20,101 overdose deaths related to prescription opioid pain relievers.

The study hopes to make both plastic surgeons and patients aware of risk factors and complications about prolonged opioid use.

 

Sources:

American Society of Plastic Surgeons. Ten Percent Rate of Prolonged Opioid Use After Breast Reconstruction. 28 November 2017.

American Society of Addiction Medicine. Opioid Addiction Disease 2016 Facts and Figures.

 

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