Many of our BRCA patients have the difficult decision of choosing to proceed with the removal of their uterus/ovaries as well as bilateral mastectomy and reconstruction. For BRCA patients who are candidates for DIEP flap, one common question is the timing of hysterectomy-oophorectomy and mastectomy reconstruction.
We had an opportunity to investigate this question while I was on the full-time faculty of The Ohio State University/James Cancer Center. Our study was published recently in the journal Microsurgery and was based on over 400 patients. In evaluating BRCA patients, we found that when it came to the overall complication rate, it did not matter if hysterectomy-oophorectomy or bilateral DIEP flap was done first.
However, we did find that certain patients who had previously had a hysterectomy-oophorectomy were not candidates for DIEP flap breast reconstruction because of an injury to the perforating blood vessels used in DIEP flap reconstruction while the hysterectomy-oophorectomy was performed either robotically or laparoscopically.
Thus, our recommendation based on the conclusions of this paper is to perform mastectomy and DIEP flap reconstruction before hysterectomy-oophorectomy. The operations should be scheduled at least three months apart to allow adequate patient time for recovery from DIEP flap reconstruction. We also found that when hysterectomy-oophorectomy is done at least three months after DIEP flap transfer, this operation may take a bit longer (average of about one-hour longer); however, there was not an increase in the complication rate despite the longer surgery. This paper helps to clarify an issue that many of our patients confront.