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Annals of Surgical Oncology

, Volume 23, Issue 1, pp 257–264 | Cite as

Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study

  • Cindy B. MatsenEmail author
  • Babak Mehrara
  • Anne Eaton
  • Deborah Capko
  • Anastasia Berg
  • Michelle Stempel
  • Kimberly J. Van Zee
  • Andrea Pusic
  • Tari A. King
  • Hiram S. CodyIII
  • Melissa Pilewskie
  • Peter Cordeiro
  • Lisa Sclafani
  • George Plitas
  • Mary L. Gemignani
  • Joseph Disa
  • Mahmoud El-Tamer
  • Monica Morrow
Reconstructive Oncology

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.

Keywords

Nipple Tissue Expander Acellular Dermal Matrix Flap Necrosis Bilateral Mastectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This study was funded in part by NIH/NCI Cancer Center Support Grant P30 CA008748.

Disclosure

There are no conflicts of interest.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Cindy B. Matsen
    • 1
    Email author
  • 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
    • 4
  • Hiram S. CodyIII
    • 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
  1. 1.Breast Care Team, Department of SurgeryHuntsman Cancer Institute at the University of UtahSalt Lake CityUSA
  2. 2.Plastic and Reconstructive Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Breast Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA

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