Outcomes in Women Undergoing Combined Breast, Plastic, and Gynecologic Surgery.

Abstract

Bilateral mastectomy and bilateral salpingo-oophorectomy (BSO) reduce cancer risks in BRCA mutation carriers. However, limited data exist on complication rates for mastectomy combined with BSO or with immediate breast reconstruction (IBR). We analyzed 83,885 female patients in NSQIP (2007-2019) undergoing mastectomy, excluding partial mastectomies. Patients were grouped by surgery type: (a) mastectomy alone, (b) mastectomy with BSO, (c) mastectomy with IBR, and (d) all three procedures. Outcomes and predictors of postoperative complications were assessed. Increased postoperative complications were associated with higher body mass index (BMI; OR 1.89, p < 0.001), diabetes (OR 1.76, p < 0.001), tobacco use (OR 1.27, p < 0.001), and higher ASA class (OR 1.72, p < 0.001). Complication rates were highest for patients undergoing mastectomy, IBR, and BSO (6.50% versus 5.76% for mastectomy alone, p = 0.0055). On multivariate analysis, only mastectomy with IBR was significantly associated with increased complications (OR 1.11, p < 0.001). Mastectomy with BSO had the lowest complication rate (5.39%, p = 0.0055) and showed no significant differences in (length of stay) LOS, readmission, or reoperation rates compared with mastectomy alone. Adding BSO to mastectomy + IBR did not significantly increase reoperation rates, supporting the safety of combined procedures. However, IBR increased complication risk and reoperation rates, emphasizing the need for preoperative risk stratification and patient counseling.