Decoding the mastectomy SKIN score: An evaluation of its predictive performance in immediate breast reconstruction Journal Article
| Authors: | Hassan, A. M.; Nguyen, H. T.; Elias, A. M.; Nelson, J. A.; Coert, J. H.; Mehrara, B. J.; Butler, C. E.; Selber, J. C. |
| Article Title: | Decoding the mastectomy SKIN score: An evaluation of its predictive performance in immediate breast reconstruction |
| Abstract: | Background: The skin ischemia and necrosis (SKIN) score was introduced to standardize the assessment of mastectomy skin flap necrosis (MSFN) severity and the need for reoperation. The authors evaluated the association between the SKIN score and the long-term postoperative outcomes of MSFN after mastectomy and immediate breast reconstruction. Methods: The authors conducted a retrospective cohort study of consecutive patients who developed MSFN after mastectomy and immediate breast reconstruction from January of 2001 to January of 2021. The primary outcome was breast-related complications after MSFN. Secondary outcomes were 30-day readmission, operating room (OR) débridement, and reoperation. Study outcomes were correlated with the SKIN composite score. Results: The authors identified 299 reconstructions in 273 consecutive patients with mean follow-up time of 111.8 ± 3.9 months. Most patients had a composite SKIN score of B2 (25.0%, n = 13), followed by D2 (17.3%) and C2 (15.4%). We found no significant difference in rates of OR débridement (P = 0.347), 30-day readmission (P = 0.167), any complication (P = 0.492), or reoperation for a complication (P = 0.189) based on the SKIN composite score. The composite skin score was a poor predictor of reoperation, with an area under the curve of 0.56. A subgroup analysis in patients who underwent implant-based reconstruction revealed no difference in rates of OR débridement (P = 0.986), 30-day readmission (P = 0.530), any complication (P = 0.492), or reoperation for a complication (P = 0.655) based on the SKIN composite score. Conclusions: The SKIN score was a poor predictor for postoperative MSFN outcomes and reoperation. An individualized risk-assessment tool that incorporates the anatomic appearance of the breast, imaging data, and patient-level risk factors is needed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV. © 2024 Lippincott Williams and Wilkins. All rights reserved. |
| Keywords: | adult; middle aged; retrospective studies; surgical flaps; mastectomy; pathology; breast neoplasms; breast reconstruction; transplantation; mammaplasty; retrospective study; necrosis; postoperative complication; postoperative complications; skin; severity of illness index; breast tumor; diagnosis; reoperation; surgery; epidemiology; etiology; adverse event; procedures; humans; human; female |
| Journal Title: | Plastic and Reconstructive Surgery |
| Volume: | 153 |
| Issue: | 6 |
| ISSN: | 0032-1052 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2024-06-01 |
| Start Page: | 1073e |
| End Page: | 1079e |
| Language: | English |
| DOI: | 10.1097/prs.0000000000010817 |
| PUBMED: | 37289944 |
| PROVIDER: | scopus |
| PMCID: | PMC11798343 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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