Combined Autologous Breast Reconstruction and Gynecologic Procedures: Does Timing Affect Clinical and Patient-Reported Outcomes?

Abstract

Background: Patients with or at risk for breast cancer may opt for risk-reducing gynecologic surgeries, including bilateral salpingo-oophorectomies and/or total abdominal hysterectomy. The timing and safety of combining these procedures with autologous breast reconstruction (ABR) are debated. This study assesses the impact of concurrent ABR and gynecologic surgeries on clinical and patient-reported outcomes.

Methods: Female patients who underwent ABR from 2010 to 2023 were included. Three groups were compared: (1) same-day ABR with gynecologic surgery, (2) staged ABR and gynecologic surgery, and (3) ABR alone. Clinical and patient-reported outcomes included operative time, length of stay (LOS), complications, return to the operating room, and BREAST-Q Physical Well-Being of the Abdomen scores.

Results: A total of 2288 patients were included. Of these, 66 had simultaneous surgeries (Group 1), 256 had staged surgeries (Group 2), and 1966 had ABR alone (Group 3). There were no meaningful differences in operative time, return to the operating room, LOS, or overall complication rates. Seroma occurrence was significantly lower in Group 3 than Group 2 (6.1% vs. 6.3% vs. 3.5%; p = 0.046) which emerged during pairwise comparisons. BREAST-Q Physical Well-Being of the Abdomen scores did not significantly differ among the three cohorts at preoperative, 6-month postoperative, and 1-year postoperative time points.

Conclusion: The findings indicate that simultaneous ABR and gynecologic surgeries do not significantly impact complication rates, operative times, hospital stays, or patient-reported abdominal well-being, supporting that simultaneous surgery as a safe and efficient approach for appropriate patients.