Preoperative use of serotonergic antidepressants is associated with increased rates of complications and surgical revision in autologous breast reconstruction

Introduction: Depression and anxiety are common among women with breast cancer scheduled for autologous breast reconstruction, with selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors serving as the first-line treatments. Although effective for mood disorders, perioperative use of these medications has been linked to impaired hemostasis and wound healing in recovering patients. We evaluated the association between preoperative serotonergic antidepressants and complications following reconstructive breast surgery. Methods: Female patients were identified from the US collaborative network within TriNetX, a globally federated database. Adults (18 years and older) who underwent autologous breast reconstruction were stratified into 2 groups: those prescribed serotonergic antidepressants within 3 months preoperatively (n = 4434), and those without any documented use (n = 13,661). Propensity score matching controlled for demographics and comorbidities. Primary outcomes were postoperative complications within 90 days. Secondary outcomes included deformity of reconstructed breast and surgical revision at 1 and 2 years. Risk ratios (RR) were used to measure associations, with statistical significance set at p < 0.05. Results: After matching, 3064 patients remained in each group. Patients who used serotonergic antidepressants before autologous breast reconstruction had significantly higher risks of developing complications, including sepsis (RR = 1.94, p = 0.004), seroma (RR = 1.58, p = 0.004), hematoma (RR = 1.29, p = 0.037), and surgical site infection (RR = 1.54, p < 0.0001), within 90 days. At 1 and 2 years, the rates of breast deformity and revision were also significantly elevated (p < 0.01). Conclusion: Preoperative serotonergic antidepressant use is associated with increased short- and long-term complications following autologous breast surgery.