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. 2016 Jan;23(1):257-64.
doi: 10.1245/s10434-015-4709-7. Epub 2015 Jul 21.

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study

Cindy B Matsen  1 , Babak Mehrara  2 , Anne Eaton  3 , Deborah Capko  4 , Anastasia Berg  4 , Michelle Stempel  4 , Kimberly J Van Zee  4 , Andrea Pusic  2 , Tari A King  5 , Hiram S Cody 3rd  4 , Melissa Pilewskie  4 , Peter Cordeiro  2 , Lisa Sclafani  4 , George Plitas  4 , Mary L Gemignani  4 , Joseph Disa  2 , Mahmoud El-Tamer  4 , Monica Morrow  4
Affiliations

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study

Cindy B Matsen et al. Ann Surg Oncol. 2016 Jan.

Abstract

Background: Rates of mastectomy with immediate reconstruction are rising. Skin flap necrosis after this procedure is a recognized complication that can have an impact on cosmetic outcomes and patient satisfaction, and in worst cases can potentially delay adjuvant therapies. Many retrospective studies of this complication have identified variable event rates and inconsistent associated factors.

Methods: A prospective study was designed to capture the rate of skin flap necrosis as well as pre-, intra-, and postoperative variables, with follow-up assessment to 8 weeks postoperatively. Uni- and multivariate analyses were performed for factors associated with skin flap necrosis.

Results: Of 606 consecutive procedures, 85 (14 %) had some level of skin flap necrosis: 46 mild (8 %), 6 moderate (1 %), 31 severe (5 %), and 2 uncategorized (0.3 %). Univariate analysis for any necrosis showed smoking, history of breast augmentation, nipple-sparing mastectomy, and time from incision to specimen removal to be significant. In multivariate models, nipple-sparing, time from incision to specimen removal, sharp dissection, and previous breast reduction were significant for any necrosis. Univariate analysis of only moderate or severe necrosis showed body mass index, diabetes, nipple-sparing mastectomy, specimen size, and expander size to be significant. Multivariate analysis showed nipple-sparing mastectomy and specimen size to be significant. Nipple-sparing mastectomy was associated with higher rates of necrosis at every level of severity.

Conclusions: Rates of skin flap necrosis are likely higher than reported in retrospective series. Modifiable technical variables have limited the impact on rates of necrosis. Patients with multiple risk factors should be counseled about the risks, especially if they are contemplating nipple-sparing mastectomy.

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Figures

Fig 1
Fig 1
Diagram of intra-operative pre-incision measurements. Incision length was measured as the horizontal distance between the lateral and medial ends of the incision. Width of skin ellipse was only used for skin-sparing procedures and was measured as the distance between the superior and inferior aspects of the incision. Length of the upper skin flap was measured from the midpoint of the superior incision to the midpoint of the clavicle.
Fig 2
Fig 2
Comparison of severity of skin flap necrosis by type of mastectomy, skin sparing (N=509) and nipple-sparing (N=95). Nipple-sparing mastectomy was associated with more severe degrees of necrosis (p<0.01).
See this image and copyright information in PMC

References

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