Mastectomy skin
necrosis is a significant problem after
breast reconstruction. This complication may lead to poor wound healing and need for implant removal, which may delay subsequent oncologic treatment. We sought to characterize factors associated with
mastectomy skin
necrosis and propose a management algorithm.
METHODS: A retrospective review was performed on consecutive patients undergoing implant-based
breast reconstruction by the senior author from 2006 through 2015. Patient-level factors including age, race, body mass index, history of
hypertension, history of diabetes, history of smoking, and history of radiation were collected. Surgical factors including type of
mastectomy, location of implant placement, and immediate versus delayed reconstruction were collected. The incidence and treatment of
mastectomy skin
necrosis were analyzed.
RESULTS: A total of 293 patients underwent either unilateral or bilateral implant-based
breast reconstructions after
mastectomy with a total of 471 reconstructed breasts.
Mastectomy skin
necrosis was observed in 8.1% of reconstructed breasts. Skin
necrosis was not associated with age,
hypertension, diabetes, prior radiation, or type of
mastectomy. The incidence of skin
necrosis was higher among smokers (17.9% vs 5.0%, P < 0.001), among patients with higher body mass index (11.4% vs 6.1%, P = 0.05), patients who underwent immediate reconstruction compared to delayed (9.6% vs 0%, P = 0.004), placement of expander under acellular dermal matrix compared with submuscular placement (12.0% vs 5.2%, P = 0.02), and use of higher initial expander fill volume compared with lower fill volume (11.4% vs 5.4%, P = 0.02).The median
necrosis size was 8 cm. The median
time to treatment was 15 days postoperatively. In 55% of patients minor
necrosis was treated with clinic
debridement, whereas 43% had larger areas of
necrosis requiring operative
debridement. The median size treated with clinic
debridement was 5.5 cm, compared to 15 cm for operative
debridement. All
necrosis was treated in a timely fashion and did not delay adjuvant
therapy.
CONCLUSIONS: