Reoperation for haematoma after breast reduction with preoperative administration of low-molecular-weight heparin: Experience in 720 patients

Background: Venous thrombo-embolism (VTE) prophylaxis is of paramount importance in the management of surgical patients. Mechanical as well as pharmacologic modalities may be used. With the use of anticoagulative agents, there is a potential for increased operative and postoperative bleeding. Aim: To assess the safety of perioperative use of low-molecular-weight heparin (LMWH) in the setting of breast reduction surgery. Methods: Retrospective assessment of the reoperation rate due to haematoma formation for breast reductions performed under a regimen of preoperative and postoperative administration of LMWH during a 10-year period. Results: A total of 720 patients (1358 breasts) received preoperative and postoperative treatment with LMWH. Reoperation due to haematoma formation was required for 37 breasts in 37 patients (5.1% of patients and 2.7% of breasts). Eight patients (1.1%) required transfusion. No patient or operative factors were associated with the need for reoperation. There were no documented cases of deep vein thrombosis or VTE. Conclusion: The use of a pre- and postoperative LMWH prophylaxis regimen is associated with a reoperation rate for haematoma that is in the upper range reported in the literature.