As more patients are identified with BRCA mutations, the number of prophylactic breast and gynecology surgeries is increasing. To accommodate these patients in one surgical setting, previous reports have demonstrated that it is safe to perform combination surgery in one operative setting. Literature shows it is safe to perform the breast portion of the procedure first, but there are no reports of combination breast and gynecology surgery where the gynecology portion preceded the breast surgery. Our aim is to demonstrate that it is safe to perform the gynecologic portion of combination surgeries first in high-risk patients undergoing risk-reducing operations.
After institutional review board approval, our hospital database was queried from 2011 to 2013. The charts of women undergoing combination breast and gynecologic surgery were identified. All women had either a BRCA mutation, a personal history of breast or gynecologic cancer, or had a first-degree relative with breast of gynecologic cancer. The charts were reviewed to identify intraoperative complications, postoperative infection, and readmissions within 30 days of the procedure.
From 2011 to 2013, 10 high-risk patients were identified who underwent combination breast and gynecologic surgery. All had the gynecologic portion preceding the breast surgery. One patient returned to the operating room for vaginal cuff approximation and one patient was readmitted for a postoperative ileus. No cases of infection were documented 30 days after the procedure in any of the 10 patients.
This series demonstrates that in high-risk patients undergoing combination breast and gynecologic surgery, the gynecologic portion of the procedure may precede the breast operation.