PURPOSE: Infection remains one of the most significant concerns after prosthetic breast reconstruction. Patients, especially BRCA carriers, often undergo mastectomy and reconstruction concurrently with risk-reducing gynecologic operations. As studies suggest longer OR times and increased OR traffic can increase infection risk, we aimed to evaluate the impact of these concurrent operations and surgery sequence on SSI rates.
METHODS: We performed a retrospective review of all patients who underwent nipple-sparing mastectomy with tissue expander or implant placement between January 2018-January 2023 with at least 6 months follow-up. We compared patients who had concurrent gynecologic procedures with those who did not, and within the concurrent group, whether the Breast or Gynecology teams operated first. Primary outcomes included minor infection (oral antibiotics only), major infection (IV antibiotics or surgery) and reconstruction loss.
RESULTS: We identified 424 patients, of which 31 (61 reconstructions) underwent concurrent gynecologic procedures. 15 patients (30 reconstructions) and 16 patients (31 reconstructions) were in the Gynecology first and Breast first groups respectively. Demographic factors and SSI rates were similar between groups. SSI rates remained similar when comparing case sequence. The Breast first vs. Gynecology first rates were as follows: Minor infection: 6% vs. 0%, p=0.16, major infection 16% vs. 7%, p=0.25, reconstruction loss: 13% vs 7%, p=0.41.
CONCLUSION: Concurrent gynecologic procedures can be performed without higher infection rates after prosthetic reconstruction. Evaluating case order may represent a straightforward intervention to reduce SSI, however our sample size currently is too small. Further data collection is ongoing to refine these findings.