Skip to main content

Advertisement

Log in

Outcomes of Concurrent Breast and Gynecologic Risk Reduction Surgery

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Women considering risk reduction surgery after a diagnosis of breast/ovarian cancer and/or inherited cancer gene mutation face difficult decisions. The safety of combined breast and gynecologic surgery has not been well studied; therefore, we evaluated the outcomes for patients who have undergone coordinated multispecialty surgery.

Methods

We conducted a retrospective review of patients undergoing simultaneous breast and gynecologic surgery for newly or previously diagnosed breast cancer and/or an inherited cancer gene mutation during the same anesthetic at a single institution from 1999 to 2013.

Results

Seventy-three patients with a mean age of 50 years (range 27–88) were identified. Most patients had newly diagnosed breast cancer or ductal carcinoma in situ (62 %) and 28 patients (38 %) had an identified BRCA mutation. Almost all gynecologic procedures were for risk reduction or benign gynecologic conditions (97 %). Mastectomy was performed in 39 patients (53 %), the majority of whom (79 %) underwent immediate reconstruction. The most common gynecologic procedure involved bilateral salpingo-oophorectomy, which was performed alone in 18 patients (25 %) and combined with hysterectomy in 40 patients (55 %). A total of 32 patients (44 %) developed postoperative complications, most of which were minor and did not require surgical intervention or hospitalization. Two of the 19 patients who underwent implant reconstruction (11 %; 3 % of the entire cohort) had major infectious complications requiring explantation.

Conclusion

Combined breast and gynecologic procedures for a breast cancer diagnosis and/or risk reduction in patients can be accomplished with acceptable morbidity. Concurrent operations, including reconstruction, can be offered to patients without negatively impacting their outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Dowdy SC, Stefanek M, Hartmann LC. Surgical risk reduction: prophylactic salpingo-oophorectomy and prophylactic mastectomy. Am J Obstet Gynecol. 2004;191:1113–1123.

    Article  PubMed  Google Scholar 

  2. King MC, Marks JH, Mandell JB. Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science. 2003;302:643-646.

    Article  CAS  PubMed  Google Scholar 

  3. Antoniou A, Pharoah PD, Narod S, et al. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet. 2003;72:1117-1130.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. National Comprehensive Cancer Network. Clinical practice guidelines in oncology. Breast cancer risk reduction. V.1.2016.http://www.nccn.org. Accessed.

  5. Burke W, Daly M, Garber J, et al. Recommendations for follow-up care of individuals with an inherited predisposition to cancer:II. BRCA1 and BRCA2. Cancer Genetics Studies Consortium. JAMA. 1997;277:997–1003.

    Article  CAS  PubMed  Google Scholar 

  6. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371–1388.

    Article  CAS  PubMed  Google Scholar 

  7. Grann VR, Jacobson JS, Whang W, et al. Prevention with tamoxifen or other hormones versus prophylactic surgery in BRCA1/2-positive women: a decision analysis. Cancer J Sci Am. 2000;6:13–20.

    CAS  PubMed  Google Scholar 

  8. Meijers-Heijboer H, van Geel B, van Putten WL, et al. Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2001;345:159–164.

    Article  CAS  PubMed  Google Scholar 

  9. Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2004;22:1055–1062.

    Article  PubMed  Google Scholar 

  10. Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340:77–84.

    Article  CAS  PubMed  Google Scholar 

  11. Rebbeck TR, Lynch HT, Neuhausen SL, et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med. 2002;346:1616–1622.

    Article  PubMed  Google Scholar 

  12. Domchek SM, Friebel TM, Singer CF, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304:967–975.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Batista LI, Lu KH, Beahm EK, et al. Coordinated prophylactic surgical management for women with hereditary breast-ovarian cancer syndrome. BMC Cancer. 2008;8:101.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Del Corral GA, Wes AM, Fischer JP, et al. Outcomes and cost analysis in high-risk patients undergoing simultaneous free flap breast reconstruction and gynecologic procedures. Ann Plast Surg. 2015;75:534–538.

    Article  PubMed  Google Scholar 

  15. Khadim MF, Eastwood P, Price J, et al. Multidisciplinary one-stage risk-reducing gynaecological and breast surgery with immediate reconstruction in BRCA-gene carrier women. Eur J Surg Oncol. 2013;39:1346–1350.

    Article  CAS  PubMed  Google Scholar 

  16. Voss SC, Sharp HC, Scott JR. Abdominoplasty combined with gynecologic surgical procedures. Obstet Gynecol. 1986;67:181–185.

    Article  CAS  PubMed  Google Scholar 

  17. Shull BL, Verheyden CN. Combined plastic and gynecological surgical procedures. Ann Plast Surg. 1988;20:552–557.

    Article  CAS  PubMed  Google Scholar 

  18. Kryger ZB, Dumanian GA, Howard MA. Safety issues in combined gynecologic and plastic surgical procedures. Int J Gynaecol Obstet. 2007;99:257–263.

    Article  CAS  PubMed  Google Scholar 

  19. Casey WJ 3rd, Rebecca AM, Andres LA, et al. Safety and efficacy of perforator flap breast reconstruction with combined intraabdominal procedures. Ann Plast Surg. 2010;64:144–150.

    Article  CAS  PubMed  Google Scholar 

  20. Garvey EM, Gray RJ, Wasif N, et al. Neoadjuvant therapy and breast cancer surgery: a closer look at postoperative complications. Am J Surg. 2013;206:894–898.

    Article  PubMed  Google Scholar 

  21. Garvey PB, Buchel EW, Pockaj BA, et al. The deep inferior epigastric perforator flap for breast reconstruction in overweight and obese patients. Plast Reconstr Surg. 2005;115:447–457.

    Article  PubMed  Google Scholar 

  22. Garvey EM, Nelson JA, Dueck AC, et al. Postoperative complications in nipple-sparing mastectomy. J Clin Oncol. 2014;32:1095.

    Google Scholar 

  23. Hester TR Jr, Baird W, Bostwick J 3rd, et al. Abdominoplasty combined with other major surgical procedures: safe or sorry? Plast Reconstr Surg. 1989;83:997–1004.

    Article  PubMed  Google Scholar 

  24. Jagsi R, Jiang J, Momoh AO, et al. Complications after mastectomy and immediate breast reconstruction for breast cancer: a claims-based analysis. Ann Surg. 2016;263:219–227.

    Article  PubMed  Google Scholar 

  25. Willsher P, Ali A, Jackson L. Laparoscopic oophorectomy in the management of breast disease. ANZ J Surg. 2008;78:670–672.

    Article  PubMed  Google Scholar 

  26. Perabò M, Fink V, Gunthner-Biller M, et al. Prophylactic mastectomy with immediate reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via a transmammary route: a novel surgical approach to female BRCA-mutation carriers. Arch Gynecol Obstet. 2014;289:1325–1330.

    PubMed  Google Scholar 

Download references

Disclosures

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Barbara A. Pockaj MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ma, I.T., Gray, R.J., Wasif, N. et al. Outcomes of Concurrent Breast and Gynecologic Risk Reduction Surgery. Ann Surg Oncol 24, 77–83 (2017). https://doi.org/10.1245/s10434-016-5479-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5479-6

Keywords

Navigation