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01-03-2013 | Reconstructive Oncology

Flap Survival of Skin-Sparing Mastectomy Type IV: A Retrospective Cohort Study of 75 Consecutive Cases

Authors: Fabio Santanelli, MD, PhD, Benedetto Longo, MD, Michail Sorotos, MD, Alessio Farcomeni, PhD, Guido Paolini, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2013

Abstract

Background

High incidence of epidermolysis and full thickness necrosis of Wise-pattern skin-sparing mastectomy (WPM) skin flaps to almost 30 % represent the Achilles’ heel of this procedure. Our purpose was to investigate potential predictors of skin flap ischemic complications (SFIC) in WPM.

Methods

A total of 75 immediate prosthetic reconstructions following Wise-pattern mastectomy on 63 patients were retrospectively analyzed to assess risk factors for SFIC and their impact on aesthetic outcomes and patient satisfaction. There were 2 clusters of hypothetic predictors investigated: patient-related (age, body mass index, smoking, neoadjuvant chemotherapy) and procedure-related (implant weight, breast weight, curative-prophylactic procedure, axillary lymph nodes dissection). Significant predictors from univariate and mixed-effects multivariate logistic regression analyses were considered to be important selection criteria that expose the patients to higher risk of SFIC. Moreover, patients were divided into 3 subgroups according to postoperative outcome: (A) group healed uneventfully, (B) with partial thickness, and (C) with full thickness necrosis. Aesthetic evaluations scores of subgroups were analyzed and compared using a Kruskal–Wallis analysis of variance, and Dunn’s test for multiple comparisons between subgroups.

Results

Smoking and weight of prosthesis >468 g showed significant association with SFIC, additionally analysis of aesthetic evaluations confirmed differences between subgroups (p = 0.001), and multiple testing showed significance between subgroup A and C (p < 0.05).

Conclusions

Patients with clinically significant predictors are at higher risk of postoperative SFIC and consequently less satisfied of their aesthetic outcomes. The surgeon should consider alternative procedures for such patients, and prostheses heavier than 468 g should be avoided.

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Title: Flap Survival of Skin-Sparing Mastectomy Type IV: A Retrospective Cohort Study of 75 Consecutive Cases
Authors: Fabio Santanelli, MD, PhD
Benedetto Longo, MD
Michail Sorotos, MD
Alessio Farcomeni, PhD
Guido Paolini, MD, PhD
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 3/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2672-0

At a glance: The STEP trials

Springer Medicine

Flap Survival of Skin-Sparing Mastectomy Type IV: A Retrospective Cohort Study of 75 Consecutive Cases

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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