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J Reconstr Microsurg 2023; 39(04): 288-294
DOI: 10.1055/a-1887-7645
Original Article

A Comparative Analysis of Risk Factors for Breast Skin Necrosis following Autologous versus Device-Based Breast Reconstruction

Marcos Lu Wang
1   Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York
,
Alyssa B. Valenti
2   Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital, New York, New York
,
Gianni Thomas
1   Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York
,
Hao Huang
1   Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York
,
Leslie E. Cohen
1   Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York
,
David M. Otterburn
1   Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York
› Author Affiliations Funding None.
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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

Note

This study was presented at the 2022 Annual Meeting of the American Society for Reconstructive Microsurgery in Carlsbad, CA.




Publication History

Received: 13 March 2022

Accepted: 23 June 2022

Accepted Manuscript online:
29 June 2022

Article published online:
03 October 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Murphy BL, Yi M, Arun BK, Gutierrez Barrera AM, Bedrosian I. Contralateral risk-reducing mastectomy in breast cancer patients who undergo multigene panel testing. Ann Surg Oncol 2020; 27 (12) 4613-4621
    CrossrefPubMedGoogle Scholar
  • 2 Annual Report to the National on the Status of Cancer. National Cancer Institute. Accessed May 09, 2021 at: https://seer.cancer.gov/statfacts/html/breast.html
    PubMedGoogle Scholar
  • 3 Dauplat J, Kwiatkowski F, Rouanet P. et al; STIC-RMI working group. Quality of life after mastectomy with or without immediate breast reconstruction. Br J Surg 2017; 104 (09) 1197-1206
    CrossrefPubMedGoogle Scholar
  • 4 Fanakidou I, Zyga S, Alikari V, Tsironi M, Stathoulis J, Theofilou P. Mental health, loneliness, and illness perception outcomes in quality of life among young breast cancer patients after mastectomy: the role of breast reconstruction. Qual Life Res 2018; 27 (02) 539-543
    CrossrefPubMedGoogle Scholar
  • 5 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32 (01) 32-38
    Google Scholar
  • 6 della Rovere GQ, Nava M, Bonomi R, Catanuto G, Benson JR. Skin-reducing mastectomy with breast reconstruction and sub-pectoral implants. J Plast Reconstr Aesthet Surg 2008; 61 (11) 1303-1308
    CrossrefPubMedGoogle Scholar
  • 7 Rivera ABG-PL, Peterson DC. Anatomy, Thorax, Breast. In: Babak Abai (ed.) Anatomy, Thorax, Breast. Treasure Island, FL: StatsPerals Publishing; 2021
    Google Scholar
  • 8 Sue GR, Long C, Lee GK. Management of mastectomy skin necrosis in implant based breast reconstruction. Ann Plast Surg 2017; 78 (5, suppl 4): S208-S211
    CrossrefPubMedGoogle Scholar
  • 9 Pataky RE, Baliski CR. Reoperation costs in attempted breast-conserving surgery: a decision analysis. Curr Oncol 2016; 23 (05) 314-321
    CrossrefPubMedGoogle Scholar
  • 10 Nykiel M, Sayid Z, Wong R, Lee GK. Management of mastectomy skin flap necrosis in autologous breast reconstruction. Ann Plast Surg 2014; 72 (Suppl. 01) S31-S34
    CrossrefPubMedGoogle Scholar
  • 11 Sue GR, Lee GK. Mastectomy skin necrosis after breast reconstruction: a comparative analysis between autologous reconstruction and implant-based reconstruction. Ann Plast Surg 2018; 80 (5S, suppl 5): S285-S287
    CrossrefPubMedGoogle Scholar
  • 12 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 2019; 43 (03) 846-852
    CrossrefPubMedGoogle Scholar
  • 13 Lee TJ, Oh TS, Kim EK. et al. Risk factors of mastectomy skin flap necrosis in immediate breast reconstruction using low abdominal flaps. J Plast Surg Hand Surg 2016; 50 (05) 302-306
    CrossrefPubMedGoogle Scholar
  • 14 Vargas CR, Koolen PG, Anderson KE. et al. Mastectomy skin necrosis after microsurgical breast reconstruction. J Surg Res 2015; 198 (02) 530-534
    CrossrefPubMedGoogle Scholar
  • 15 Matsen CB, Mehrara B, Eaton A. et al. Skin flap necrosis after mastectomy with reconstruction: a prospective study. Ann Surg Oncol 2016; 23 (01) 257-264
    CrossrefPubMedGoogle Scholar
  • 16 Margenthaler JA, Gan C, Yan Y. et al. Oncologic safety and outcomes in patients undergoing nipple-sparing mastectomy. J Am Coll Surg 2020; 230 (04) 535-541
    CrossrefPubMedGoogle Scholar
  • 17 Christopher AN, Morris MP, Broach RB, Serletti JM. A comparative analysis of immediate and delayed-immediate breast reconstruction after postmastectomy radiation therapy. J Reconstr Microsurg 2021; 38 (06) 499-505 (e-pub ahead of print). DOI: 10.1055/s-0041-1740123.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Pittelkow E, DeBrock W, Christopher L. et al. Advantages of the delayed-immediate microsurgical breast reconstruction: extending the choice. J Reconstr Microsurg 2022
    PubMedGoogle Scholar
  • 19 Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Can J Cardiol 2018; 34 (05) 575-584
    CrossrefPubMedGoogle Scholar
  • 20 Touyz RM, Briones AM. Reactive oxygen species and vascular biology: implications in human hypertension. Hypertens Res 2011; 34 (01) 5-14
    CrossrefPubMedGoogle Scholar
  • 21 Wadley AJ, Veldhuijzen van Zanten JJ, Aldred S. The interactions of oxidative stress and inflammation with vascular dysfunction in ageing: the vascular health triad. Age (Dordr) 2013; 35 (03) 705-718
    CrossrefPubMedGoogle Scholar
  • 22 Virdis A, Masi S, Colucci R. et al. Microvascular endothelial dysfunction in patients with obesity. Curr Hypertens Rep 2019; 21 (04) 32
    CrossrefPubMedGoogle Scholar