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.
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.
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.
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.