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Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study

医学 乳房切除术 外科 脂肪坏死 坏死 乳房再造术 回顾性队列研究 单变量分析 前瞻性队列研究 乳腺癌 多元分析 内科学 癌症
作者
Cindy B. Matsen,Babak J. Mehrara,Anne Eaton,Deborah Capko,Anastasia L. Berg,Michelle Stempel,Kimberly J. Van Zee,Andrea L. Pusic,Tari A. King,Hiram S. Cody,Melissa Pilewskie,Peter G. Cordeiro,Lisa M. Sclafani,George Plitas,Mary L. Gemignani,Joseph J. Disa,Mahmoud El‐Tamer,Monica Morrow
出处
期刊:Annals of Surgical Oncology [Springer Nature]
卷期号:23 (1): 257-264 被引量:116
标识
DOI:10.1245/s10434-015-4709-7
摘要

Rates of mastectomy with immediate reconstruction are rising. Skin flap necrosis after this procedure is a recognized complication that can have an impact on cosmetic outcomes and patient satisfaction, and in worst cases can potentially delay adjuvant therapies. Many retrospective studies of this complication have identified variable event rates and inconsistent associated factors. A prospective study was designed to capture the rate of skin flap necrosis as well as pre-, intra-, and postoperative variables, with follow-up assessment to 8 weeks postoperatively. Uni- and multivariate analyses were performed for factors associated with skin flap necrosis. Of 606 consecutive procedures, 85 (14 %) had some level of skin flap necrosis: 46 mild (8 %), 6 moderate (1 %), 31 severe (5 %), and 2 uncategorized (0.3 %). Univariate analysis for any necrosis showed smoking, history of breast augmentation, nipple-sparing mastectomy, and time from incision to specimen removal to be significant. In multivariate models, nipple-sparing, time from incision to specimen removal, sharp dissection, and previous breast reduction were significant for any necrosis. Univariate analysis of only moderate or severe necrosis showed body mass index, diabetes, nipple-sparing mastectomy, specimen size, and expander size to be significant. Multivariate analysis showed nipple-sparing mastectomy and specimen size to be significant. Nipple-sparing mastectomy was associated with higher rates of necrosis at every level of severity. Rates of skin flap necrosis are likely higher than reported in retrospective series. Modifiable technical variables have limited the impact on rates of necrosis. Patients with multiple risk factors should be counseled about the risks, especially if they are contemplating nipple-sparing mastectomy.
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