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01-01-2016 | Reconstructive Oncology

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study

Authors: Cindy B. Matsen, MD, Babak Mehrara, MD, Anne Eaton, MS, Deborah Capko, MD, Anastasia Berg, BS, Michelle Stempel, MPH, Kimberly J. Van Zee, MD, Andrea Pusic, MD, Tari A. King, MD, Hiram S. Cody III, MD, Melissa Pilewskie, MD, Peter Cordeiro, MD, Lisa Sclafani, MD, George Plitas, MD, Mary L. Gemignani, MD, Joseph Disa, MD, Mahmoud El-Tamer, MD, Monica Morrow, MD

Published in: Annals of Surgical Oncology | Issue 1/2016

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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Title: Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study
Authors: Cindy B. Matsen, MD
Babak Mehrara, MD
Anne Eaton, MS
Deborah Capko, MD
Anastasia Berg, BS
Michelle Stempel, MPH
Kimberly J. Van Zee, MD
Andrea Pusic, MD
Tari A. King, MD
Hiram S. Cody III, MD
Melissa Pilewskie, MD
Peter Cordeiro, MD
Lisa Sclafani, MD
George Plitas, MD
Mary L. Gemignani, MD
Joseph Disa, MD
Mahmoud El-Tamer, MD
Monica Morrow, MD
Publication date: 01-01-2016
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 1/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4709-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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