Perioperative Calcitonin Gene‐Related Peptide Inhibitor Use and Wound Complications After Free Flap Breast Reconstruction: A Retrospective Cohort Study

BACKGROUND: As the prevalence of migraines and breast cancer morbidity rise among women globally, it is imperative to consider that female patients undergoing breast reconstruction may also be receiving migraine treatment such as calcitonin gene-related peptide (CGRP) inhibitors. CGRP is a neuropeptide involved in migraine pathogenesis and plays a critical role in wound repair, raising concerns that CGRP inhibition may impair wound healing. This study evaluates the perioperative impact of CGRP inhibitor use following free flap breast reconstruction. METHODS: A single-center retrospective study was conducted including adult female migraine patients who underwent free flap breast reconstruction between November 2018 and December 2024. Patients treated with CGRP inhibitors within 30 days before and/or after surgery were compared with those not receiving CGRP inhibitors. Demographics, comorbidities, migraine-related medications, and perioperative outcomes were collected and analyzed. RESULTS: Among 1338 free flap breast reconstruction patients, 81 had a documented migraine diagnosis. Thirteen patients (25 flaps) comprised the CGRP-treated cohort, and 68 patients (117 flaps) served as controls. CGRP inhibitor use was associated with significantly higher rates of flap skin necrosis (16.0% vs. 5.1%, OR 5.78, p = 0.028) and delayed wound healing (20.0% vs. 8.5%, OR 3.85, p = 0.048). Time to healing from wound complications was significantly prolonged in the CGRP group (100.1 vs. 75.7 days, adjusted β = 21.1, p = 0.008). CONCLUSION: This study represents the first comparative cohort analysis suggesting that perioperative CGRP inhibitor use was potentially associated with increased postoperative wound healing complications. Careful perioperative medication assessment may be warranted for migraine patients undergoing autologous breast reconstruction.