Strategies to avoid mastectomy skin-flap necrosis during nipple-sparing mastectomy

• DOI: 10.1093/bjs/znad107
• Publication Date: 2023-05-13T13:39:17Z
• Authors: Tracy-Ann Moo; Jonas A Nelson; Varadan Sevilimedu; Jillian Charyn; Tiana V Le; Robert J Allen; Babak J Mehrara; Andrea V Barrio; Deborah M Capko; Melissa Pilewskie; Alexandra S Heerdt; Audree B Tadros; Mary L Gemignani; Monica Morrow; Virgilio Sacchini
• Keywords: Inframammary fold; Fat necrosis

Abstract Background Nipple-sparing mastectomy is associated with a higher risk of skin-flap necrosis than conventional skin-sparing mastectomy. There are limited prospective data examining modifiable intraoperative factors that contribute to after nipple-sparing Methods Data on consecutive patients undergoing between April 2018 and December 2020 were recorded prospectively. Relevant variables documented by both breast plastic surgeons at the time surgery. The presence extent nipple and/or was first postoperative visit. Necrosis treatment outcome 8–10 weeks association clinical analysed, significant included in multivariable logistic regression analysis backward selection. Results Some 299 underwent 515 mastectomies (54.8 per cent (282 515) prophylactic, 45.2 therapeutic). Overall, 23.3 breasts (120 developed or necrosis; 45.8 these (55 120) had only. Among 120 necrosis, 22.5 superficial, 60.8 partial, 16.7 full-thickness necrosis. On analysis, predictors sacrificing second intercostal perforator (P = 0.006), greater tissue expander fill volume < 0.001), non-lateral inframammary fold incision placement 0.003). Conclusion Modifiable may decrease likelihood include lateral fold, preserving perforating vessel, minimizing volume.