Background
Venous thromboembolism (VTE) is a significant perioperative complication that must be considered in major surgeries, including breast reduction surgery. Breast mammoplasty, especially as a bilateral procedure, carries a similar risk of VTE to other major surgical procedures due to operative factors, reduced postoperative mobility and patient-specific risk factors. There is limited direction in Australasian guidelines and literature specific to VTE prophylaxis in bilateral breast mammoplasty without concurrent abdominal procedures. This scoping review aims to synthesise existing evidence and recommendations regarding VTE prophylaxis in patients undergoing bilateral breast reduction.
Methods
Due to the paucity of Australasian literature and procedure-specific guidance, this review draws on international studies and Australasian hospital protocols to identify best practices, highlight inconsistencies, and examine gaps in the current literature. A comprehensive database search was conducted using PubMed, Scopus, Google Scholar, and Australasian health databases. Studies included report VTE incidence, associated risk factors, VTE prophylaxis protocols and relevant guidelines for breast surgery.
Results
Findings reveal significant international variation in thromboprophylaxis practices, particularly regarding the duration of pharmaceutical prophylaxis. While international bodies broadly recommend risk stratification tools, mechanical prophylaxis and pharmaceutical prophylaxis for high-risk individuals, no universally accepted approach exists. Australasian VTE prevention guidelines, including those published by state health departments and surgical colleges, primarily offer general surgical recommendations and do not specifically address breast reduction surgery. Consequently, clinical decisions in Australasia often rely on hospital-based protocols or clinician judgement.
Conclusion
This review provides an overview of VTE incidence and risk factors in breast surgery and compares global and local practices in VTE prevention. Discussion also includes general surgical recommendations including perioperative risk assessment, mechanical prophylaxis and pharmacological prophylaxis. Ultimately, this research emphasises the need for Australasian guidelines tailored to breast reduction surgery. Establishing standardised recommendations will support consistent, evidence-based clinical decision-making and improve patient safety and outcomes.