Plastic Surgery Research Council

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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.

Percentages of Patients with Complications
Infection Requiring IV AbxNecrosis Requiring SurgeryTE Exchange for New TESeromaHematomaTE or Implant RuptureAnatomic Implant RotationDVT or PEOther Complications
Group1 (GCR+, GYN+, n=26)
Group2 (GCR+, GYN+, n=41)7.37.3012.22.404.902.4
Group3 (GCR-, GYN+, n=5)000000000
Group4 (GCR-, GYN-, n=197)
F, p (ANOVA) df btw grps =3, df wthn grps = 265.2, .88.1, .95.7, .53.3, .82.8, .49.4, .78.1, .93N/A.1, .94
p (Tukey HSD) - If applicableN/AN/AN/AN/AN/AN/AN/AN/AN/A

Number of Surgeries and Percentages of Patients Undergoing Certain Surgeries
Mean number of Complication-related surgeries before implantMean number of Complication-related surgeries after implantMean number of Revision surgeriesMean number of Total surgeriesPercentage of patients with at least one complication-related surgery before implantPercentage of patients with at least one complication-related surgery after implantPercentage of patients with at least one revision surgery
Group1 (GCR+, GYN+, n=26).
Group2 (GCR+, GYN-, n=41).
Group3 (GCR-, GYN+, n=5).20.22.620.0020.0
Group4 (GCR-, GYN-, n=197).
F, p (ANOVA), df between groups=3, df within groups = 265.1, .95.2, .891.3, .27.9, .45.6, .64.1, .931.4, .23
p (Tukey HSD) if applicableN/AN/AN/AN/AN/AN/AN/A

Age, BMI, Percentages of Patients with Comorbidities
Age (yrs)BMI (kg/m2)Percentage with Smoking HistoryPercentage with HypertensionPercentage with Diabetes
Group1 (GCR+, GYN+,n=26)47.023.615.419.27.7
Group2 (GCR+, GYN-, n=41)42.0*
Group3 (GCR-, GYN+, n=5)44.623.840.020.00
Group4 (GCR-, GYN-, n=197)48.5*24.322.822.82.5
F, p (ANOVA), df between groups=3, df within groups = 2653.2, .02.4, .75.6, .641.2, .311.3, .28
p (Tukey HSD) if applicable.01N/AN/AN/AN/A

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