Can breast augmentation cause non-ST-elevation myocardial infarction (NSTEMI)?

Breast Augmentation and Non-ST-Elevation Myocardial Infarction (NSTEMI)

Breast augmentation surgery is not a recognized direct cause of NSTEMI in current cardiovascular guidelines, but certain perioperative factors associated with the procedure may potentially increase cardiac risk in susceptible individuals.

Understanding NSTEMI

NSTEMI is defined as an acute process of myocardial ischemia with sufficient severity and duration to result in myocardial necrosis, detected by cardiac biomarkers indicative of myocardial damage, without ST-segment elevation on ECG 1. The primary mechanism is typically atherosclerotic coronary artery disease (CAD) with plaque disruption and thrombosis, leading to decreased myocardial oxygen supply.

Potential Mechanisms Linking Breast Augmentation to NSTEMI

While breast augmentation is not directly cited as a cause of NSTEMI in cardiovascular guidelines, several perioperative factors could potentially contribute to cardiac events:

1. Surgical Stress Response:

   • Surgery induces a systemic inflammatory response and catecholamine surge
   • Increases myocardial oxygen demand while potentially decreasing supply
   • Can trigger coronary vasospasm or thrombosis in susceptible individuals

2. Anesthesia-Related Factors:

   • Hemodynamic fluctuations during general anesthesia
   • Potential hypotension or hypertension affecting coronary perfusion

3. Pre-existing Cardiovascular Risk:

   • Patients with undiagnosed or known CAD may experience demand ischemia
   • Surgical stress may destabilize pre-existing coronary plaques

Risk Assessment and Prevention

For patients considering breast augmentation with cardiovascular risk factors:

1. Preoperative Evaluation:

   • Thorough cardiovascular risk assessment
   • Consider stress testing in patients with multiple risk factors
   • Optimize medical management of hypertension, diabetes, and other conditions

2. Perioperative Management:

   • Maintain hemodynamic stability
   • Ensure adequate pain control to minimize stress response
   • Continue essential cardiac medications through the perioperative period

Special Considerations

Women with known coronary disease or significant risk factors should receive particular attention:

• Women with previous NSTEMI should consider delaying elective breast augmentation for at least 90-180 days after the cardiac event, especially if coronary revascularization was performed 2
• Patients with hypertension may be at higher risk for cardiac events triggered by particulate matter and surgical stress 3

Conclusion

While breast augmentation is not directly identified as a cause of NSTEMI in cardiovascular guidelines, the physiological stress of surgery could potentially trigger cardiac events in patients with pre-existing risk factors. Careful preoperative cardiovascular risk assessment and optimization of modifiable risk factors are essential to minimize the risk of perioperative cardiac complications.