Impact of Combined Gynecologic Procedures on Two Staged Implant-Based Breast Reconstruction in Patients with Genetic Cancer Risks
Savanah N. Hampton, BSA1, Avinash P. Jayaraman, BA1, Lekshmi A. Nair, BS2, Christopher Venutolo, BA1, Min J. Cho, MD1, Sumeet S. Teotia, MD1, Nicholas T. Haddock, MD1.
1The University of Texas Southwestern Medical Center, Dallas, TX, USA, 2Texas Tech University Health Science Center, Lubbock, TX, USA.
PURPOSE: Patients sometimes undergo combined mastectomy, risk reducing gynecologic procedures, and breast reconstruction during one OR visit. We explored this method's impact on surgical outcomes in patients with and without genetic cancer risks (GCR).
METHODS: We retrospectively reviewed 542 breast reconstructions, performed by two surgeons (SST,NTH) at one tertiary care academic hospital from January 2012 to February 2016. Patients choosing implants and completing reconstruction (n=269) were split into 4 groups based on GCR status and combined gynecologic procedures (GYN) status: GCR+, GYN+ (Group1,n=26); GCR+, GYN- (Group2,n=41); GCR-, GYN+ (Group3,n=5); GCR-, GYN- (Group4,n=197). GCR included mutations in BRCA, CHEK2, PALB2, Li-Fraumeni Syndrome, and others. One-way ANOVA (df between groups = 3, df within groups = 265) and Tukey HSD was performed to compare differences in the percentages of patients with necrosis requiring surgery, infection requiring IV antibiotics, seroma, and device exchange.
RESULTS: Co-morbidities and age were equivalent between groups, except for Group2 (42yrs) and Group4(48.5yrs), p=.02. Rates of infection requiring IV antibiotics (p=.88), necrosis requiring surgery (p=.95), seroma (p=.82) and device exchange (p=.53) were equivalent. There were no significant differences in the mean number of complication-related surgeries before (p=.95) or after (p=.89) implant, revision surgeries (p=.27), or total surgeries (p=.45). There were no significant differences in the percentages of patients undergoing at least one complication-related surgery before implant (p=.64), at least one complication-related surgery after implant (p=.93), or at least one revision surgery (p=.23).
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. Subgroup analysis revealed no significant differences in complication rates. Patients who would benefit from combined risk-reducing gynecologic procedures can be encouraged to do so.
|Infection Requiring IV Abx||Necrosis Requiring Surgery||TE Exchange for New TE||Seroma||Hematoma||TE or Implant Rupture||Anatomic Implant Rotation||DVT or PE||Other Complications|
|Group1 (GCR+, GYN+, n=26)||3.9||7.7||0||.7.7||0||0||3.9||0||3.9|
|Group2 (GCR+, GYN+, n=41)||7.3||7.3||0||12.2||2.4||0||4.9||0||2.4|
|Group3 (GCR-, GYN+, n=5)||0||0||0||0||0||0||0||0||0|
|Group4 (GCR-, GYN-, n=197)||6.6||7.1||3.1||9.6||5.6||1.5||5.6||0||10.2|
|F, p (ANOVA) df btw grps =3, df wthn grps = 265||.2, .88||.1, .95||.7, .53||.3, .82||.8, .49||.4, .78||.1, .93||N/A||.1, .94|
|p (Tukey HSD) - If applicable||N/A||N/A||N/A||N/A||N/A||N/A||N/A||N/A||N/A|
|Mean number of Complication-related surgeries before implant||Mean number of Complication-related surgeries after implant||Mean number of Revision surgeries||Mean number of Total surgeries||Percentage of patients with at least one complication-related surgery before implant||Percentage of patients with at least one complication-related surgery after implant||Percentage of patients with at least one revision surgery|
|Group1 (GCR+, GYN+, n=26)||.3||.08||.6||2.9||23.1||3.9||34.6|
|Group2 (GCR+, GYN-, n=41)||.2||.02||.4||2.7||24.4||2.4||26.8|
|Group3 (GCR-, GYN+, n=5)||.2||0||.2||2.6||20.0||0||20.0|
|Group4 (GCR-, GYN-, n=197)||.2||.06||.6||2.9||16.84||4.1||42.1|
|F, p (ANOVA), df between groups=3, df within groups = 265||.1, .95||.2, .89||1.3, .27||.9, .45||.6, .64||.1, .93||1.4, .23|
|p (Tukey HSD) if applicable||N/A||N/A||N/A||N/A||N/A||N/A||N/A|
|Age (yrs)||BMI (kg/m2)||Percentage with Smoking History||Percentage with Hypertension||Percentage with Diabetes|
|Group1 (GCR+, GYN+,n=26)||47.0||23.6||15.4||19.2||7.7|
|Group2 (GCR+, GYN-, n=41)||42.0*||25.0||24.4||9.8||0|
|Group3 (GCR-, GYN+, n=5)||44.6||23.8||40.0||20.0||0|
|Group4 (GCR-, GYN-, n=197)||48.5*||24.3||22.8||22.8||2.5|
|F, p (ANOVA), df between groups=3, df within groups = 265||3.2, .02||.4, .75||.6, .64||1.2, .31||1.3, .28|
|p (Tukey HSD) if applicable||.01||N/A||N/A||N/A||N/A|
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