Purpose:

The practice of combining planned breast reconstruction and gynecologic surgical procedures has been discouraged due to concerns over increased risks of patient morbidity.� Theoretical risks of such combined procedures include prolonged operative time, increased blood loss, and an increased rate of peri-operative complications. ��The purpose of this study was to prospectively evaluate the intraoperative and postoperative morbidity in patients undergoing combined breast reconstruction and gynecologic procedures.

Methods:

A review of all combined gynecologic and breast reconstruction procedures performed at a tertiary cancer center from March 1998 until March 2004 was performed.� �Demographic, operative, and postoperative data were obtained from a prospectively-maintained, clinical database.� Peri-operative complications were evaluated.�� Secondary outcomes measures including: mean operative time, length of hospital stay, rate of peri-operative blood transfusions, and delay to adjuvant therapy were collected.  

Results:

Over the 6 year period, 51 patients underwent simultaneous breast reconstruction procedures with gynecologic surgical procedures. �Immediate reconstruction was performed in 36% of patients. �In total, 38 tissue expander/implant breast reconstructions, 6 autogenous tissue reconstructions (5 free TRAM flaps; 1 Latissimus Dorsi flap), and 7 nipple-areolar complex reconstructions were performed. Thirty-nine laproscopic and 12 non-laproscopic gynecologic procedures were performed simultaneously with the breast reconstructive procedures. There were no thromboembolic events or fatalities in this series.� The overall complication rate for the combined breast reconstructive and gynecologic procedures was 7.8% (4/51). �The most common peri-operative complication was infection 5.8% (3/51); despite this, there was no delay to adjuvant therapy in these patients. The mean total operative time for all combined gynecologic and breast reconstructive procedures was 5.28 hours (range 1.27 � 13.35 hours).� The mean hospital stay was 3.0 days (range; 0 � 9 days).� Six percent (3/51) of patients received a blood transfusion in the peri-operative period.� All three of these patients had undergone a combined autogenous tissue breast reconstruction and gynecologic procedure.  

Conclusion:

The practice of combining breast reconstructive and gynecologic surgical procedures is safe and reliable in appropriately selected patients.� Complication rates following the combined procedures are similar to those following each procedure performed separately.� Benefits include a single hospitalization, a single period of anesthesia, and reduced operating costs with combined surgical procedures.�