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

• Published in: World journal of surgery Vol. 43; no. 3; pp. 846 - 852
• Main Authors: Ito, Hiroki, Ueno, Takayuki, Suga, Hirotaka, Shiraishi, Tomohiro, Isaka, Hirotsugu, Imi, Kentaro, Miyamoto, Kaisuke, Tada, Manami, Ishizaka, Yoshiharu, Imoto, Shigeru
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 15.03.2019; Springer Nature B.V
• Subjects: Abdominal Surgery; Body mass; Body mass index; Body size; Body weight; Breast cancer; Cancer; Cardiac Surgery; Gangrene; General Surgery; Mastectomy; Medicine; Medicine & Public Health; Multivariate analysis; Necrosis; Original Scientific Report; Patients; Risk analysis; Risk factors; Silicones; Skin; Statistical analysis; Surgery; Thoracic Surgery; Tumors; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-018-4852-y

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.