Abstract and Introduction
Background: Breast cancer resulting from a genetic mutations, such as BRCA1 or BRCA2, is seen in 5 to 10 percent of patients. More widespread genetic testing has increased the number of affected women undergoing prophylactic mastectomy and oophorectomy. Recent studies have yielded mixed results regarding complication rates after combined breast and ovarian operations. The authors compared surgical outcomes of breast operations performed in combination with salpingo-oophorectomies or as separate procedures.
Methods: The authors retrospectively analyzed surgical complications and length of hospital stay in 145 female patients, from which 87 had undergone combined breast surgery and salpingo-oophorectomy, and 58 had undergone these procedures separately. Multivariate logistic regression models were used to calculate odds ratios and 95 percent confidence intervals.
Results: Patients undergoing combined breast and ovarian operations experienced higher rates of overall complications (46.5 percent versus 19 percent; p < 0.001), infections (22.2 percent versus 8.6 percent; p < 0.05), and delayed wound healing (13.2 percent versus 0 percent; p < 0.05) related to the breast surgery, when compared with patients undergoing separate procedures. Multivariate logistic regression analysis confirmed a significant association between combined surgery and overall postoperative complications (OR, 5.87; 95 percent CI, 2.03 to 16.91; p = 0.02). Patients undergoing tissue expander–based breast reconstruction combined with ovarian surgery had significantly longer hospital stays compared to patients undergoing separate procedures (3.5 days versus 1.8 days; p < 0.001).
Conclusions: The authors' data indicate that combining breast and ovarian operations is associated with a higher risk of postoperative complications related to the breast procedure and increases the duration of hospital stay in patients with tissue expander–based reconstructions. The authors' study provides valuable information for preoperative counseling of patients considering both breast and ovarian surgery.
Clinical Question/Level of Evidence: Therapeutic, III.
Heterozygous mutations in BRCA1 or BRCA2, which are major breast and ovarian tumor suppressor genes, occur in 0.2 to 0.3 percent of the female population, affecting 500,000 women in the United States. BRCA mutations are associated with a strongly increased risk for breast and ovarian cancer of 60 percent and 59 percent in BRCA1, and 55 percent and 17 percent in BRCA2, respectively, by age 70.[1,2] Because of the autosomal dominant inheritance of BRCA mutations, children have at least a 50 percent risk of inheriting the trait, which is associated with an increased risk of developing breast cancer starting around the age of 25 and ovarian cancer starting around the age of 40.
The growing public awareness about familial breast and ovarian cancer, not least triggered by the "Angelina Jolie effect," has led to a significant increase in genetic testing for BRCA1 and BRCA2 mutations. This corresponded to a rise in the number of risk-reducing bilateral mastectomies being performed in the United States since 2013. Furthermore, novel multigene panel analyses allow for simultaneous testing of additional mutations in breast cancer–associated genes. Although some of these mutations, such as CHEK2 or PALB2, are relatively common in the general population with a lower breast cancer risk than BRCA1/2, other mutations, such as CDH1 or TP53, are more rare but have a higher risk of breast cancer compared to BRCA1/2. Because of an increased number of breast cancer gene mutations being identified during genetic testing, the number of women requesting preventive surgery addressing familial cancer is continuously rising, with more patients likely being diagnosed as testing improves.
Because of better understanding and diagnosis of familial breast and ovarian cancer, more women are choosing to undergo risk-reducing bilateral mastectomy and oophorectomy. In addition to healthy mutation carriers, breast cancer patients with a positive BRCA diagnosis are candidates for prophylactic contralateral mastectomy and bilateral oophorectomy because of their increased risk. A further indication for combined mastectomy and oophorectomy are gender reassignment operations. Although coordinated multispecialty breast and ovarian surgery reduces the number of separate hospitalizations and anesthesia times, previous studies have yielded mixed results with regard to the overall postoperative outcomes of combined compared to separate breast and gynecologic operations.[10–14] The goal of this study was to compare patients who have undergone breast operations and salpingo-oophorectomies either individually or as combined procedures to determine the impact on postoperative surgical complication rates and duration of hospital stay.
Plast Reconstr Surg. 2022;149(5):1050-1059. © 2022 Lippincott Williams & Wilkins