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Patients sometimes undergo combined mastectomy, risk-reducing gynecologic procedures, and breast reconstruction during one OR visit. We explored this method’s impact on reconstruction outcomes in patients with and without genetic cancer risks (GCR).
METHODS:
We retrospectively reviewed 443 tissue expander-based breast reconstructions, performed by two surgeons at one tertiary-care academic hospital from January 2012 to February 2016. Patients were split into groups by GCR status and combined gynecologic procedures (GYN) status: GCR+, GYN+ (Group 1,n=39); GCR+, GYN- (Group 2,n=73); GCR-, GYN+ (Group 3,n=9); GCR-, GYN- (Group 4,n=327). GCR included mutations in BRCA, CHEK2, PALB2, and others. Rates of reconstruction loss and percentages of patients choosing flaps were calculated using ANOVA and Tukey-HSD. For patients completing implant-based reconstruction (n=269) ANOVA and Tukey-HSD was used for statistical analysis.
RESULTS:
Among all patients, co-morbidities and age were equivalent, except between Group 2 (43.3 yrs) and Group 4 (50 yrs), p<.01. Rates of reconstruction loss and percentage of patients choosing flaps-based reconstruction were equivalent. Among implant patients, co-morbidities and age were equivalent except for Group 2 (42 yrs) and Group 4 (48.5 yrs), p=.02. Complication rates were equivalent between groups. There were no significant differences in the mean number of complication-related surgeries before (p=.79) or after (p=.76) implant, revision surgeries (p=.34), or total surgeries (p=.52). Percentages of patients undergoing at least one complication-related surgery before implant (p=.81), at least one complication-related surgery after implant (p=.60), or at least one revision surgery (p=.48) were equivalent.
CONCLUSIONS:
When comparing patients that completed implant-based reconstruction, combining risk-reducing gynecologic procedures with mastectomy and reconstruction into one OR visit does not appear to negatively impact reconstructive outcomes.