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Review
. 2017 Mar 13:9:141-152.
doi: 10.2147/BCTT.S81712. eCollection 2017.

Mastectomy skin flap necrosis: challenges and solutions

Stuart A Robertson  1 , Johann A Jeevaratnam  2 , Avi Agrawal  2 , Ramsey I Cutress  3
Affiliations
Review

Mastectomy skin flap necrosis: challenges and solutions

Stuart A Robertson et al. Breast Cancer (Dove Med Press). .

Abstract

Introduction: Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%-30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions.

Methods: A MEDLINE search was performed using the search term "mastectomy skin flap necrosis". Titles and abstracts from peer-reviewed publications were screened for relevance.

Results: MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited.

Conclusion: MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem.

Keywords: breast surgery; complication; flap; mastectomy; necrosis.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
A photograph showing T-junction MSFN after skin-reducing mastectomy and dermal sling-assisted implant reconstruction. Note: The dermal sling provided a vascularized bed, protecting the implant beneath and facilitating formation of healthy granulation tissue, permitting healing by secondary intention. Abbreviation: MSFN, mastectomy skin flap necrosis.
Figure 2
Figure 2
Potential consequences of MSFN. Abbreviation: MSFN, mastectomy skin flap necrosis.
Figure 3
Figure 3
A flow diagram showing selection of articles for review.
See this image and copyright information in PMC

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