Ischemic Complications After Bilateral Nipple-sparing Mastectomy and Implant-based Reconstruction: A Critical Analysis. Issue 5 (June 2021)

• Record Type: Journal Article
• Authors: Razavi, S. Amir; Hart, Alexandra L.; Carlson, Grant W.
• Is Part Of: Annals of plastic surgery. Volume 86:Issue 5(2021)Supplement 6
• Publication Date: 2021-06
• Subjects: nipple-sparing mastectomy -- skin necrosis; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000002703
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Purpose: Nipple-sparing mastectomy (NSM) has a higher incidence of mastectomy skin flap necrosis (MSFN) than skin-sparing mastectomy. The purpose of this study is to analyze predisposing factors for nipple and skin necrosis after bilateral NSM with immediate implant reconstruction. Methods: Sixty-two consecutive patients (124 breasts) from a single breast/plastic surgeon underwent bilateral NSM with immediate implant-based breast reconstruction were included. Factors influencing MSFN were analyzed. Results: The mean age was 45.7 years, and mean body mass index was 22.9. Reconstructive methods were as follows: tissue expander (TE), 76 (61.3%); and direct to implant, 48 (38.7%). Mastectomy skin flap necrosis occurred in 39 (31.5%) breasts, nipple necrosis 38 and skin flap necrosis 19. Thirty-seven breasts healed uneventfully, and 2 (1.6%) required reoperation. Cancer pathology, mastectomy weight greater than 279 g, TE reconstruction, and nipple-notch (N-N) distance greater than 23 cm were predictive of nipple necrosis on univariate analysis. The mean mastectomy weight (380.1 g vs 220.7 g, P < 0.0001), N-N distance greater than 23 cm (30 vs 0, P < 0.0001), and mean implant size (490 cm 3 vs 373 cm 3, P < 0.0001) were greater in the TE group. On logistic regression model controlling for all significant variables, predictors of MSFN were as follows: diagnosis of cancer (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.41–8.03; P = 0.006), TE reconstruction (OR, 2.87; 95% CI, 1.03–8.03; P = 0.04), and N-N distance (OR, 1.31; 95% CI, 1.03–1.66; P = 0.03). Conclusions: Mastectomy skin flap necrosis after NSM and implant reconstruction is common. In this series, only 2 (1.6%) cases required surgical intervention with no implant loss. Treatment of breast cancer, TE reconstruction, and increasing N-N notch distance were positive predictors of MSFN.