Strategies to avoid mastectomy skin-flap necrosis during nipple-sparing mastectomy Journal Article
| Authors: | Moo, T. A.; Nelson, J. A.; Sevilimedu, V.; Charyn, J.; Le, T. V.; Allen, R. J. Jr; Mehrara, B. J.; Barrio, A. V.; Capko, D. M.; Pilewskie, M.; Heerdt, A. S.; Tadros, A. B.; Gemignani, M. L.; Morrow, M.; Sacchini, V. |
| Article Title: | Strategies to avoid mastectomy skin-flap necrosis during nipple-sparing mastectomy |
| Abstract: | Background: Nipple-sparing mastectomy is associated with a higher risk of mastectomy skin-flap necrosis than conventional skin-sparing mastectomy. There are limited prospective data examining modifiable intraoperative factors that contribute to skin-flap necrosis after nipple-sparing mastectomy. Methods: Data on consecutive patients undergoing nipple-sparing mastectomy between April 2018 and December 2020 were recorded prospectively. Relevant intraoperative variables were documented by both breast and plastic surgeons at the time of surgery. The presence and extent of nipple and/or skin-flap necrosis was documented at the first postoperative visit. Necrosis treatment and outcome was documented at 8-10 weeks after surgery. The association of clinical and intraoperative variables with nipple and skin-flap necrosis was analysed, and significant variables were included in a multivariable logistic regression analysis with backward selection. Results: Some 299 patients underwent 515 nipple-sparing mastectomies (54.8 per cent (282 of 515) prophylactic, 45.2 per cent therapeutic). Overall, 23.3 per cent of breasts (120 of 515) developed nipple or skin-flap necrosis; 45.8 per cent of these (55 of 120) had nipple necrosis only. Among 120 breasts with necrosis, 22.5 per cent had superficial, 60.8 per cent had partial, and 16.7 per cent had full-thickness necrosis. On multivariable logistic regression analysis, significant modifiable intraoperative predictors of necrosis included sacrificing the second intercostal perforator (P = 0.006), greater tissue expander fill volume (P < 0.001), and non-lateral inframammary fold incision placement (P = 0.003). Conclusion: Modifiable intraoperative factors that may decrease the likelihood of necrosis after nipple-sparing mastectomy include incision placement in the lateral inframammary fold, preserving the second intercostal perforating vessel, and minimizing tissue expander fill volume. © 2023 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. |
| Keywords: | adult; human tissue; aged; debridement; retrospective studies; major clinical study; plastic surgery; postoperative period; prospective study; prospective studies; sentinel lymph node biopsy; mastectomy; breast neoplasms; breast reconstruction; mammaplasty; graft necrosis; retrospective study; necrosis; postoperative complication; postoperative complications; intraoperative period; breast tumor; operation duration; nipple; subcutaneous mastectomy; mastectomy, subcutaneous; nipples; povidone iodine; nipple-sparing mastectomy; axillary lymph node dissection; skin flap; hyperbaric oxygen therapy; plastic surgeon; humans; human; female; article; bacitracin; fluorescence angiography |
| Journal Title: | British Journal of Surgery |
| Volume: | 110 |
| Issue: | 7 |
| ISSN: | 0007-1323 |
| Publisher: | Oxford University Press |
| Date Published: | 2023-07-01 |
| Start Page: | 831 |
| End Page: | 838 |
| Language: | English |
| DOI: | 10.1093/bjs/znad107 |
| PUBMED: | 37178195 |
| PROVIDER: | scopus |
| PMCID: | PMC10517092 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in PubMed and PDF -- Corresponding author is MSK author: Virgilio Sacchini -- Source: Scopus |
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