DVT or Pulmonary Embolism (PE) Prophylaxis in Breast Surgery

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The risk of DVT or pulmonary embolism (PE):
    • Is very low with most breast operations
    • The exception is breast operations:
      • Having long duration of general anesthesia and autologous reconstruction with flaps
  • No specific prophylaxis for DVT / PE is necessary for breast operations:
    • Performed with local or regional anesthesia
  • Ambulation and leg compression stockings:
    • Are adequate for prophylaxis of DVT / PE in the vast majority of patients undergoing breast surgery in a report from MD Anderson Cancer Center
  • Aspirin:
    • Is not considered sufficient prophylaxis for any patient at moderate to high risk for DVT / PE
  • Vena cava filters decrease the risk of PE but do not prevent DVT
  • The most effective method to decrease a repeat DVT in a patient at moderate risk:
    • Is with chemoprophylaxis with:
      • Low molecular weight heparin or low dose unfractionated heparin given preoperatively, then continued
  • References
    • Andtbacka RH, Babiera G, Singletary SE, Hunt KK, Meric-Bernstam F, Feig BW, et al. Incidence and prevention of venous thromboembolism in patients undergoing breast cancer surgery and treated according to clinical pathways. Ann Surg. 2006;243(1):96-101.
    • El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245(5):665-671.
    • Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ; American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl);7S-47S.
    • Neumayer L, Schifftner TL, Henderson WG, Khuri SF, El-Tamer M. Breast cancer surgery in Veterans Affairs and selected university medical centers: results of the patient safety in surgery study. J Am Coll Surg. 2007;204(6):1235-1241.

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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