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

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.

Publikationsverlauf

Eingereicht: 13. März 2022

Angenommen: 23. Juni 2022

Accepted Manuscript online:
29. Juni 2022

Artikel online veröffentlicht:
03. Oktober 2022

• 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
• 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
• 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
• 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
• 5 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32 (01) 32-38
• 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
• 7 Rivera ABG-PL, Peterson DC. Anatomy, Thorax, Breast. In: Babak Abai (ed.) Anatomy, Thorax, Breast. Treasure Island, FL: StatsPerals Publishing; 2021
• 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
• 9 Pataky RE, Baliski CR. Reoperation costs in attempted breast-conserving surgery: a decision analysis. Curr Oncol 2016; 23 (05) 314-321
• 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
• 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
• 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
• 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
• 14 Vargas CR, Koolen PG, Anderson KE. et al. Mastectomy skin necrosis after microsurgical breast reconstruction. J Surg Res 2015; 198 (02) 530-534
• 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
• 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
• 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.
• 18 Pittelkow E, DeBrock W, Christopher L. et al. Advantages of the delayed-immediate microsurgical breast reconstruction: extending the choice. J Reconstr Microsurg 2022
• 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
• 20 Touyz RM, Briones AM. Reactive oxygen species and vascular biology: implications in human hypertension. Hypertens Res 2011; 34 (01) 5-14
• 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
• 22 Virdis A, Masi S, Colucci R. et al. Microvascular endothelial dysfunction in patients with obesity. Curr Hypertens Rep 2019; 21 (04) 32