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Risk Factors for Skin Flap Necrosis in Breast Cancer Patients Treated with Mastectomy Followed by Immediate Breast Reconstruction

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Abstract

Background

Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) are the standard techniques for achieving a cosmetic outcome, but necrosis of a cutaneous flap including the nipple–areolar complex (NAC) is a serious complication. To analyze the risk factors for skin flap necrosis, we retrospectively evaluated a clinical database of breast cancer patients treated with mastectomy followed by immediate breast reconstruction.

Methods

Four hundred and twelve cases were consecutively recorded between 2006 and 2016. Body weight (BW), body mass index (BMI), distance from NAC to referent tumor, distance from overlying skin to the tumor and weight of breast resection (WBR) as measured in the operating theater were included in the statistical analysis.

Results

NSM, SSM and total mastectomy were performed in 123 (30%), 96 (23%) and 193 cases (47%), respectively. A tissue expander was used in 379 cases (92%), a silicone implant in 8 (2%) and autologous breast reconstruction in 25 (6%). Skin flap necrosis was found in 7% of all cases and NAC necrosis in 13% of NSM cases. In a univariate analysis, BW, NSM and WBR were risk factors for skin flap necrosis, and BW, BMI and WBR were risk factors for NAC necrosis. In a multivariate analysis, NSM and WBR remained significant risk factors for skin flap necrosis, and WBR was a significant risk factor for NAC necrosis.

Conclusions

WBR is an important risk factor for skin flap necrosis. Especially, NAC necrosis should be considered for patients with large-volume breasts who undergo NSM and immediate breast reconstruction.

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Acknowledgements

The first author would like to thank Dr. Ouellette Tomoyo, Director of Kaneko Clinic, for her clinical advice.

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Authors and Affiliations

  1. Department of Breast Surgery, Kaneko Clinic, Kagoshima, Kagoshima, Japan

    Hiroki Ito

  2. Breast Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Minatoku, Tokyo, Japan

    Takayuki Ueno

  3. Department of Plastic Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan

    Hirotaka Suga & Tomohiro Shiraishi

  4. Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Hiroki Ito, Takayuki Ueno, Hirotsugu Isaka, Kentaro Imi, Kaisuke Miyamoto, Manami Tada, Yoshiharu Ishizaka & Shigeru Imoto

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  1. Hiroki Ito
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  2. Takayuki Ueno
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  3. Hirotaka Suga
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Corresponding author

Correspondence to Shigeru Imoto.

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All authors declare that they have no conflict of interest.

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Ito, H., Ueno, T., Suga, H. et al. Risk Factors for Skin Flap Necrosis in Breast Cancer Patients Treated with Mastectomy Followed by Immediate Breast Reconstruction. World J Surg 43, 846–852 (2019). https://doi.org/10.1007/s00268-018-4852-y

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  • DOI: https://doi.org/10.1007/s00268-018-4852-y

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