No need to stop antidepressants before plastic surgery, evidence suggests
There is no consistent evidence that taking antidepressants increases the risk of bleeding, breast cancer or other adverse outcomes from plastic surgery, according to a research review published in this month’s issue of Plastic and Reconstructive Surgery*, the official medical journal of the American Society of Plastic Surgeons (ASPS).
In addition stopping antidepressants before plastic and reconstructive surgery is unlikely to reduce complications and might increase the risk of postoperative problems related to the patient's underlying depression, according to the report by Dr Isabel Teo of Ninewells Hospital, Dundee, and medical student Christopher Tam Song of University of Edinburgh.
Abstract
Background: Antidepressant use has increased dramatically over the past decade. Although there is no question about the benefits of these medications, uncertainty exists with regard to the implications of antidepressant treatment surrounding plastic surgery. This systematic review collates all of the available literature that evaluates the risks of patient antidepressant treatment, in relation to plastic surgery.
Methods: A comprehensive literature review of the PubMed and Cochrane databases was conducted. Articles were assessed by two independent reviewers using predefined data fields and selected using specific inclusion criteria. The two authors independently reviewed the literature and extracted data from included reviews, and discrepancies were resolved by consensus.
Results: Twenty-six articles were included in the analysis and were categorized into five groups for comparison: risk of bleeding, risk of breast cancer, risk of breast cancer recurrence, breast enlargement, and miscellaneous (unique complications). Extracted information included study type, statistical analyses, conclusion, and limitations.
Conclusions: This review does not support the cessation of antidepressants in patients before plastic surgery, as the numbers needed to harm are low and the implications of withdrawal may prove to be detrimental to postoperative management. However, the use of antidepressants for mental disorders may also implicate key patient risk factors for surgical complications, and sufficient exploration into the patient’s indications for the prescription is crucial. Evidence so far does not suggest that antidepressants increase the risk of breast cancer or recurrence in general, but caution should be exercised for those specifically on concurrent tamoxifen and paroxetine treatment.
*Teo, Isabel M.R.C.S.; Song, Christopher Tam M.B.Ch.B. Assessing the Risks Associated with Antidepressant Use in Plastic Surgery: A Systematic Review. Plastic & Reconstructive Surgery. November 2015 - Volume 136 - Issue 5 - p1107–1119
