Management of Mastectomy Skin Flap Necrosis in Autologous Breast Reconstruction ANNALS OF PLASTIC SURGERY Nykiel, M., Sayid, Z., Wong, R., Lee, G. K. 2014; 72: S31-S34


Mastectomy skin flap necrosis is a significant problem in the autologous breast reconstruction. The necrosis may create unsightly scarring, produce contour irregularities, and deform the breast mound. This may lead to a poor reconstruction and patient satisfaction. Most importantly, the development and treatment of mastectomy skin flap necrosis can delay further oncologic treatment.We performed a retrospective chart review of all patients undergoing autologous breast reconstruction in the past 5 years to examine our incidence and treatment of mastectomy skin flap necrosis. We then used these data to create a management algorithm for mastectomy skin flap necrosis. The goals of this algorithm were as follows: (1) to not delay further oncologic treatment, (2) to expedite the healing time while minimizing patient risk, and (3) to create an aesthetically pleasing breast reconstruction.A retrospective chart review from 2008 to 2013 was performed of all autologous breast reconstruction at our institution. We then analyzed our data and patient outcomes and developed a treatment algorithm.We identified 204 patients who underwent autologous free flap breast reconstruction that was performed by the senior author (G.K.L.). Our incidence of mastectomy skin necrosis was 30%. There was no delay in adjuvant oncologic treatment for any of our patients. The development of mastectomy skin necrosis was significant for patients with diabetes (P=0.03), current tobacco use (P=0.04), and body mass index (P=0.01). The time for wound healing was prolonged in patients with a high body mass index (P=0.04). Regression analysis of wound size showed full-thickness wounds greater than 6 cm benefited from operative closure.Our incidence of mastectomy skin necrosis was 30%. Despite our high incidence mastectomy skin necrosis, we had no delays in adjuvant oncologic treatment. Retrospective data analysis allowed us to then develop a management algorithm for mastectomy skin necrosis. We feel it is advantageous to the patient and the reconstructive outcome to heal the breast wounds in the acute phase (within 3 weeks); and with regression analysis, we found full-thickness wounds greater than 6 cm benefit from operative intervention. Finally, patients requiring adjuvant oncologic treatment should be healed as quickly as possible so they may continue on with their oncologic care.

View details for DOI 10.1097/SAP.0000000000000174

View details for PubMedID 24667879