Safety of Biologic and Immune-modulating Agents in Breast Surgery Procedures: A Retrospective Cohort Analysis.

BACKGROUND

Biologic and targeted immune-modulating agents are increasingly used to manage autoimmune diseases like rheumatoid arthritis, psoriasis, and inflammatory bowel disease. As more patients receiving these therapies undergo elective breast augmentation and implant-based reconstruction, the effect of biologic exposure on postoperative outcomes remains unclear.

OBJECTIVES

This study evaluated whether preoperative use of biologic or immune-modulating agents is associated with increased complications following reconstructive and aesthetic breast surgery procedures.

METHODS

A retrospective cohort analysis was performed using the TriNetX database. Patients who underwent breast reconstruction or augmentation were identified by Current Procedural Terminology codes and stratified by preoperative exposure to biologic or immune-modulating agents within six months of surgery. Agents included tumor necrosis factor-α, interleukin, Janus kinase, mammalian target of rapamycin, and calcineurin inhibitors, among others. Propensity score matching (1:1) controlled for demographic and clinical covariates. Postoperative complications were assessed at 30-days, 90-days, and 6-months and included wound dehiscence, infection, seroma or hematoma, implant revision, and hospital readmission.

RESULTS

Among 211,105 patients, 4,024 had biologic exposure and 207,081 were controls. After propensity score matching, 3,980 patients remained in each cohort. Complication rates were comparable between groups at all timepoints (p > 0.05). Biologic exposure was not associated with increased risk of wound, infectious, implant revision, or hospital readmission complications.

CONCLUSIONS

Preoperative biologic or immune-modulating therapy was not associated with a significant increase in postoperative surgical complications after breast reconstruction or augmentation procedures. Continuing these therapies in appropriate patients appears safe and may reduce unnecessary treatment interruptions.