Ten Percent Rate of Prolonged Opioid Use After Breast Reconstruction

Ten percent of women who undergo mastectomy and immediate breast reconstruction are still taking prescription opioid pain medications three months after surgery, suggests a study in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Prolonged opioid use is common after breast reconstruction, according to the research by Jennifer F. Waljee, MD, MPH, MS, and colleagues of University of Michigan, Ann Arbor. They urge plastic and reconstructive surgeons to be aware of the risk of persistent opioid use after breast reconstruction, and to seek alternative methods of postoperative pain control when possible.

Opioid Use Persists for Many Breast Reconstruction Patients

Using a health benefits claims database, the researchers identified 4,113 women who underwent mastectomy for breast cancer and immediate breast reconstruction between 2010 and 2014. All patients were "opioid-naive," with no opioid prescriptions within the previous year.

Pharmacy claims data showed that 90 percent of patients filled an opioid prescription after breast reconstruction. That was consistent with previous studies reporting high rates of opioid use after other common, "low-risk" surgical procedures.

Three months later, ten percent of women continued to fill an opioid prescription. Prolonged opioid use was more common for women diagnosed with anxiety and for those who experienced some type of complication—most commonly infection.

Prolonged opioid use was less likely for women receiving chemotherapy, and for those undergoing breast reconstruction using their own tissues (autologous reconstruction), as opposed to implants. About three-fourths of the women had breast reconstruction using implants. Women diagnosed with depression received higher doses of opioids, as did those who underwent reconstruction of both breasts (bilateral reconstruction). Opioid doses were lower for women aged 55 to 64, compared to younger patients.

As for many types of surgery, opioids are the "mainstay" for pain control after mastectomy and breast reconstruction. Amid the ongoing opioid crisis, there is increased attention to the risk of dependence and prolonged use of opioids prescribed after surgery. Most opioid prescribing guidelines focus on patients with chronic pain, rather than postoperative pain. Patients with cancer may be especially susceptible to opioid dependence. Breast reconstruction is the most common type of cancer reconstruction—US plastic surgeons performed more than 109,000 breast reconstructions in 2016, according to ASPS statistics.

The new study focuses attention on the large number of women who continue to take opioids several months after breast reconstruction. It also identifies patient- and procedure-related risk factors for prolonged or higher-dose opioid use, including implant-based breast reconstruction, bilateral reconstruction, and anxiety or depression.

Dr. Waljee and coauthors conclude, "Close consultation with providers in primary care, psychiatry, and pain management during the postoperative period can provide more coordinated care with opioid alternatives for these complex and potentially vulnerable patients."

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "Prescription Opioid Use among Opioid-Naive Women Undergoing Immediate Breast Reconstruction"

Article: "Prescription Opioid Use among Opioid-Naive Women Undergoing Immediate Breast Reconstruction" (doi: 10.1097/PRS.0000000000003832)