C. R. Vargas1, M. Paul1, P. G. Koolen1, K. E. Anderson1, B. T. Lee1 1Beth Israel Deaconess Medical Center,Surgery / Plastic And Reconstructive Surgery,Boston, MA, USA
Introduction:
Mastectomy skin flap necrosis represents a significant clinical morbidity following autologous breast reconstruction. In addition to aesthetic deformity, necrosis of the native mastectomy skin may require debridement, additional reconstruction, and prolonged wound care, and can delay planned oncologic treatment. This study aims to evaluate seven potential patient and procedural factors in order to identify predictors of mastectomy skin necrosis.
Methods:
A retrospective review was performed of all immediate autologous breast reconstruction procedures performed at a single academic center between January 2004 and December 2013. Patient records were queried for age, mastectomy weight, pre-operative radiation therapy, pre-operative chemotherapy, diabetes, active smoking, previous breast surgery, and post-operative mastectomy skin flap necrosis. Mastectomy weight was divided into quartiles for improved clinical interpretability.
Results:
There were 698 immediate autologous microsurgical flaps performed by three surgeons at our institution during the study period; mean patient age was 49.3±8.3 years and average mastectomy weight was 769.3±413 grams. The incidence of mastectomy skin flap necrosis was 13%. Univariate analysis revealed a significantly higher incidence of mastectomy skin necrosis in patients with diabetes (p = 0.017) as well as those with higher mastectomy weight (p = 0.001). No significant association was found for age, pre-operative radiation, pre-operative chemotherapy, active smoking, or previous breast surgery. Multivariate analysis, adjusted for clustering related to bilateral reconstruction, demonstrated a statistically significant association between mastectomy skin necrosis and increasing mastectomy weight (OR 1.54, p < 0.001). The association between diabetes and mastectomy skin necrosis was not significant after covariate adjustment.
Conclusion:
Increasing mastectomy weight is significantly associated with post-operative mastectomy skin necrosis following autologous reconstruction. This factor should be considered during patient counseling, procedure selection, and operative planning. Interestingly, patient age, pre-operative chemotherapy, radiation, active smoking, and previous breast surgery did not predict a significantly higher risk of mastectomy skin necrosis.