| Abstract: |
Background: Mastectomy skin flap necrosis (MSFN) is a common complication following mastectomy that causes significant distress to patients and physicians and also compromises oncologic, surgical, and quality-of-life outcomes. Objectives: We sought to investigate the long-term outcomes of MSFN following implant-based reconstruction (IBR) and determine the rates and predictors of post-MSFN complications. Methods: This was a 20-year analysis of consecutive adult (>18 years) patients who developed MSFN following mastectomy and IBR from January 2001 to January 2021. Multivariable analyses were performed to identify factors associated with post-MSFN complications. Results: We identified 148 reconstructions, with a mean follow-up time of 86.6 ± 52.9 months. The mean time from reconstruction to MSFN was 13.3 ± 10.4 days, and most cases (n = 84, 56.8%) were full-thickness injuries. Most cases (63.5%) were severe, 14.9% were moderate, and 21.6% were mild. Forty-six percent (n = 68) developed a breast-related complication, with infection being the most common (24%). An independent predictor of overall complications was longer time from reconstruction to MSFN (odds ratio [OR], 1.66; P =. 040). Aging was an independent predictor of overall complications (OR, 1.86; P =. 038); infection (OR, 1.72; P =. 005); and dehiscence (OR, 6.18; P =. 037). Independent predictors of dehiscence were longer interval from reconstruction to MSFN (OR, 3.23; P =. 018) and larger expander/implant size (OR, 1.49; P =. 024). Independent predictors of explantation were larger expander/implant size (OR, 1.20; P =. 006) and nipple-sparing mastectomy (OR, 5.61; P =. 005). Conclusions: MSFN is associated with high risk of complications following IBR. Awareness of the timing and severity of MSFN and the predictors of post-MSFN complications is crucial for guiding evidence-based decision-making and improving outcomes. Level of Evidence: 4: © 2023 The Author(s). Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. |
