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Skin-Sparing Mastectomy Flap Complications After Breast Reconstruction: Review of Incidence, Management, and Outcome

Hultman, C. Scott MD; Daiza, Sumer MD

doi: 10.1097/01.SAP.0000046784.70583.E1
Original Articles
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This study assesses the incidence and outcome of skin-sparing mastectomy (SSM) flap complications after breast reconstruction. The authors performed a retrospective review of 37 consecutive patients undergoing SSM and immediate breast reconstruction, focusing on preoperative demographics, management of complications, and early outcome. Univariate analysis comparing patients with and without complications was performed using Student's t-test and chi-square analysis. From July 2000 to December 2001, 37 patients (mean age 48.1, range 24–71 y) underwent SSM and breast reconstruction (unilateral 20, bilateral 17) via TRAM flaps (n = 18), latissimus flaps (n = 13), and expander/implants (n = 6). SSM flap complications occurred in nine patients (24.3%) and included mild (n = 2), moderate (n = 5), and severe (n = 2) skin loss, resulting in four cases of dehiscence, five reoperations, and no delay in postoperative adjuvant therapy (required in six patients). Previous irradiation (n = 5, p = 0.045) and diabetes (n = 3, p = 0.001) were associated with SSM flap complications, but age, smoking, previous breast cancer, and type of reconstruction were not. Patients with SSM flap loss had a higher body mass index (BMI) than those without complications (30.0 vs. 24.3;p = 0.025). Skin flap complications after SSM and breast reconstruction are not uncommon but did not delay the initiation of adjuvant chemotherapy or radiotherapy, despite the need for reoperation. Patients with elevated BMI, diabetes, and previous irradiation may be at increased risk for SSM flap complications.

Thirty-seven women underwent skin-sparing mastectomy and immediate reconstruction with TRAM flaps (18), latissimus flaps (13), and expander/implants (6). Complications (9 flap losses, 4 dehiscences, 5 reoperations) were associated with previous irradiation, diabetes, and high body mass index but did not result in delayed adjuvant treatment.

From Division of Plastic and Reconstructive Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.

Received Oct 1, 2002.

Accepted Oct 8, 2002.

Address correspondence and reprint requests to C. Scott Hultman, MD, Assistant Professor, Division of Plastic and Reconstructive Surgery, 184 Medical School Wing D, University of North Carolina, Chapel Hill, NC 27599-7195. E-mail: cshult@med.unc.edu

Presented at the Southeastern Society of Plastic and Reconstructive Surgeons, Hilton Head, South Carolina, June 1–5, 2002. Supported in part by a Junior Faculty Development Award, Committee on Faculty Research, University of North Carolina, Chapel Hill.

Hultman CS, Daiza S. Skin-sparing mastectomy flap complications after breast reconstruction: review of incidence, management, and outcome.

© 2003 Lippincott Williams & Wilkins, Inc.