NESPS - Combined autologous breast reconstruction and gynecologic procedures: does timing affect clinical and patient-reported outcomes?

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Combined autologous breast reconstruction and gynecologic procedures: does timing affect clinical and patient-reported outcomes?
Janet Coleman-Belin¹, Minji Kim¹, Lillian Boe², Nima Khavanin¹, Sameer Massand¹, Francis Graziano¹, Jonas Nelson¹, Robert Allen¹
^¹Section of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, USA; ²Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, USA

Background
Many patients with or at increased risk for breast cancer opt for prophylactic gynecologic surgeries, including bilateral salpingo-oophorectomies (BSO) and/or total abdominal hysterectomy (TAH). The safety and timing for combining these gynecologic surgeries with autologous breast reconstruction (ABR) are under debate.

Methods
Adult female patients who underwent ABR at a tertiary medical center from 2010 to 2023 were included. We compared three groups: 1) simultaneous same-day ABR with gynecologic surgery, 2) staged ABR and gynecologic surgery, and 3) ABR alone. Outcomes included operative time, length of stay (LOS), complications, return to the operating room (OR), and BREAST-Q Physical Well-Being of the Abdomen scores (assessed preoperatively and at 6 months and 1 year postoperatively). Kruskal-Wallis Rank sum, Chi-squared, and Fisher's exact test compared three groups. Multiple imputation accounted for missing BREAST-Q scores.

Results
Of 2,288 patients, 66 had simultaneous surgeries (Group 1), 256 had staged surgeries (Group 2), and 1,966 had ABR alone (Group 3). Operative time did not significantly differ between ABR groups (bilateral reconstruction: 582 minutes [IQR: 501, 656] vs. 533 [456, 636] vs. 546 [480, 627]; p=0.13; unilateral reconstruction: 416 minutes [345, 451] vs. 408 [327, 512] vs. 387 [325, 482]; p=0.3). While statistically significant (p=0.025), LOS did not meaningfully increase. There were no significant differences between groups in return to OR (p=0.4) or overall complication rates (p=0.3). Only seroma occurrence statistically differed (6.1% vs. 6.3% vs. 3.5%; p=0.046) but not in pairwise comparisons with Group 1. There were no significant differences across cohorts in BREAST-Q Physical Well-Being of the Abdomen scores at preoperative, 6-month, and 1-year time points (all p>0.3).

Conclusion
The study suggests that concurrent ABR with gynecologic surgeries safely combines risk-reducing procedures and does not meaningfully increase operative time, LOS, complications, or affect well-being compared to sequential surgeries or ABR alone.

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