Abstract
Background Mastectomy skin flap necrosis often necessitates prolonged wound care, surgical re-excision,
and it increases the risk for infection. This study aims to compare rates of skin
flap necrosis between autologous and device-based reconstructions and identify risk
factors.
Methods The authors retrospectively identified patients who underwent immediate breast reconstruction
using either the deep inferior epigastric perforator (DIEP) flap (n = 373 breasts, 41%) or tissue expanders (n = 529 breasts, 59%) by two surgeons at a single institution between 2011 and 2021.
The rate of skin flap necrosis between autologous and device-based reconstructions
was compared and multivariate regression analysis was performed to identify risk factors.
Results There was no significant difference in rates of skin flap necrosis between the two
cohorts (26.8 vs. 15.5%, p = 0.052). Across all patients, hypertension and body mass index >30 were significant
predictors of necrosis (p = 0.024 and p <0.001, respectively). Within our DIEP cohort, mastectomy specimen weight was a significant
risk factor for necrosis (p = 0.001). The DIEP flap weight itself did not confer a higher risk for necrosis (p = 0.8).
Conclusion Immediate autologous reconstruction does not place patients at higher risk of skin
necrosis. Hypertension and obesity (body mass index >30) were independent risk factors
for necrosis in all patients. Mastectomy specimen weight was a significant predictor
of necrosis in DIEP flap patients while the DIEP flap weight itself did not increase
the risk for necrosis.
Keywords
breast reconstruction - necrosis - risk factors
