Combination Risk-Reducing Breast, Gynecologic and Reconstructive Surgery among High-Risk Women: Does Surgical Order Impact Outcome?

Academic Article

Abstract

  • © 2016, Mary Ann Liebert, Inc. Background: As the number of patients diagnosed with BRCA mutations increases, the number of risk-reducing procedures also increasing. Previous researchers have documented that it is safe to perform combination surgery, including risk-reducing mastectomies and salpingo-oophorectomies, under the same anesthesia. Objective: The aim of this study was to examine, retrospectively, surgical outcomes of women undergoing combination cancer-risk reducing breast, gynecologic, and breast-reconstruction surgery. Design: This was a retrospective cohort study. Materials and Methods: Two hospital databases were searched from January 2011, to March 2014. Charts of women undergoing risk-reducing breast-gynecologic surgery together with breast reconstruction were identified. All patients had the gynecologic portion of the surgery preceding the breast surgery. High-risk qualifiers for study inclusion were: BRCA mutation; personal history of breast or gynecologic cancer; or first-degree relative with breast or gynecologic cancer. All surgeries were performed by the same team of surgeons, and Surgical Care Improvement Project guidelines were followed. Charts were reviewed to identify rates of surgical-site infections (SSIs), intraoperative complications, postoperative infection, and readmissions within 30 days of surgery. Results: Twelve high-risk patients underwent risk-reducing breast/gynecologic surgery together with first-stage breast reconstruction. No cases of SSI were documented within 30 days following the procedures in any of the 12 patients. One patient returned to the operating room for vaginal-cuff reapproximation and 1 was readmitted for a postoperative ileus that resolved with conservative management. Conclusions: This retrospective cohort demonstrates that, in high-risk women undergoing risk-reducing breast and gynecologic surgery together with breast reconstruction, operative teams can consider performing the gynecologic portion of the procedure first. This preliminary data should be confirmed with multicenter randomized controlled trials.
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    Author List

  • Sinkey RG; Pavelka JC; Guenther JM; Schuler KM; Basil JB
  • Start Page

  • 124
  • End Page

  • 128
  • Volume

  • 32
  • Issue

  • 2