Postmenopausal Hormone Replacement Therapy is not Associated with Increased Postoperative Complications After Breast Surgery: A Propensity Matched Study
In brief
Hormone therapy showed no increase in 90-day complications after breast reconstruction
In matched groups of 3,750 postmenopausal patients each, hormone therapy was not associated with higher 90-day rates of death, blood clots, infection or wound-healing problems after breast surgery and reconstruction. Patients having reconstruction with their own tissue had more revisions by one year if they used hormones; the database study cannot establish cause and effect.
- Journal
- Annals of surgical oncology (Q1)
- Published
- 26 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Ellen S Deng, Charlotte Thomas, Bradley Colarusso, Ranjna Sharma, Ryan P Cauley
- PMID
- 42932120
- DOI
- 10.1245/s10434-026-20810-1
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 28 October 2026): Large comparative study of HRT and breast reconstruction complications
Abstract
BACKGROUND: Breast surgery and reconstruction rates in the USA continue to rise, with over 90% of new breast cancer diagnoses occurring in peri- or postmenopausal women. Despite the relevance of menopause to wound healing, postoperative outcomes in this population remain understudied. Estrogen hormone replacement therapy (HRT) may aid wound healing and menopausal symptoms, but carries prothrombotic risk. We investigate postsurgical outcomes after breast surgery and reconstruction among postmenopausal patients on HRTs compared to those without HRT use. PATIENTS AND METHODS: Using the TriNetX database, we compared patients with and without HRT use within 1 year preceding breast reconstruction. Mastectomy and reconstruction procedures were identified using CPT codes. HRT use was identified using ICD-10 and RxNorm codes. Cohorts were propensity-matched for demographics and comorbidities. Risk differences with 95% confidence intervals were calculated for outcomes within 90 days postoperatively. Analyses were performed within TriNetX, with significance set at P < 0.05. RESULTS: Two cohorts were generated, with 3750 HRT+ and 75503 HRT- patients. After propensity matching, two cohorts of 3750 patients each were created. After propensity adjustment, there was no significant association between HRT use and postoperative mortality, VTE, or wound healing complications, which were comparably low across all surgery types. Among patients undergoing autologous reconstruction, 1-year revision rates were higher in the HRT+ cohort. CONCLUSIONS: Systemic hormone replacement therapy was not associated with an increased complications after breast reconstruction, including mortality, thrombosis, infection, and wound dehiscence. Further prospective studies across surgical populations are needed to validate these findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.