Delayed Bleeding With Variable Presentations in Implant-Based Breast Reconstruction During Adjuvant Ado-Trastuzumab Emtansine (Kadcyla) Therapy: Two Case Reports
10.4048/jbc.2025.0278
- Author:
Seong Jun RYU
;
Young Seok KIM
;
In Sik YUN
;
Kyunghyun MIN
;
Joon JEONG
;
Tai Suk ROH
- Publication Type:Case Report
- From:Journal of Breast Cancer
2026;29(2):192-201
- CountryRepublic of Korea
- Language:English
-
Abstract:
Ado-trastuzumab emtansine (T-DM1) is an effective adjuvant therapy for human epidermal growth factor receptor 2-positive breast cancer; however, its surgical safety profile remains unclear. We observed delayed bleeding with variable and often subtle clinical manifestations during implant-based breast reconstruction (IBBR). Two patients who received adjuvant T-DM1 therapy after IBBR were retrospectively reviewed. The patient in Case 1 developed a recurrent seroma and liquefied hematoma requiring repeated aspirations, with platelet counts decreasing from 218 × 109 /L to 33 × 109 /L before expander removal.The patient in Case 2 experienced an acute massive hematoma on postoperative day (POD) 2, prior to T-DM1 initiation, which resolved after re-exploration; a temporally distinct delayed hemorrhagic event occurred on POD 175 during T-DM1 therapy after radiotherapy, accompanied by a platelet nadir of 34 × 109 /L. Both patients required plateletpheresis and prolonged drainage. Delayed bleeding during T-DM1 therapy may reflect a combination of hematological suppression and vascular vulnerability. Therefore, vigilant surveillance and cautious postoperative rehabilitation are warranted.
