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Predictors of Mastectomy Flap Necrosis in Patients Undergoing Immediate Breast Reconstruction: A Review of 718 Patients

Abedi, Nasim BSc, MD; Ho, Adelyn L. MD, MPH; Knox, Aaron BSc, MD; Tashakkor, Yashar MD; Omeis, Tyler BSc; Van Laeken, Nancy FRCSC; Lennox, Peter FRCSC; Macadam, Sheina A. FRCSC, MS

doi: 10.1097/SAP.0000000000000262
Breast Surgery

Background Mastectomy flap necrosis (MFN) after mastectomy and immediate breast reconstruction can compromise postsurgical recovery, lead to additional surgeries, and compromise aesthetic outcome. The objective of this study was to determine if there is a difference in the rate of MFN in patients undergoing immediate alloplastic versus immediate autologous breast reconstruction. The secondary objective was to identify additional patient and surgical factors that may influence the rate of MFN.

Methods A retrospective chart review of patients who underwent immediate breast reconstruction between 2003 and 2011 in the University of British Columbia Breast Program was performed. Demographic, oncologic, reconstructive, and surgical data were compiled.

Results Approximately 404 alloplastic and 314 autologous patients were reviewed. The overall rate of MFN was 12.9%. There was a trend toward a higher MFN rate in the autologous patient group (15.2% vs 11.6%, P = 0.095). After controlling for age, body mass index (BMI), smoking status, preoperative breast radiation, surgery duration, cancer side, mastectomy type, and postoperative chemotherapy, no association was found between reconstruction type and MFN. BMI greater than 30, smoking status, and preoperative radiation were independent predictors of MFN. Surgical factors including longer duration of surgery and Wise pattern mastectomy incision were also found to be associated with increased odds of MFN.

Conclusion We found no difference in the rate of MFN when comparing immediate alloplastic and autologous reconstruction methods. A number of patient and surgical factors were found to be predictors of MFN. The results of this large, retrospective study will help surgeons to tailor their reconstruction based on a patient’s risk factors to minimize the incidence of MFN.

From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, University of British Columbia; and †University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.

Received January 27, 2014, and accepted for publication, after revision, April 10, 2014.

Conflict of Interest and sources of funding: No funding was received for this study or for the preparation of this article. Dr. Peter Lennox is a paid consultant for LifeCell and Allergan.

Reprints: Dr. Nasim Abedi, BSc, MD, Plastic Surgery Resident, Post Graduate Year V, Plastic and Reconstructive Surgery, University of British Columbia, Vancouver General Hospital 2nd Floor, Jim Pattison Pavilion North, 855 W. 12th. Ave., Vancouver, BC V5Z1M9, Canada. E-mail:

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