title: Use of tumescent mastectomy technique as a risk factor for native breast skin flap necrosis following immediate breast reconstruction.
abstract: BACKGROUND
  Native breast skin flap necrosis is a complication that can result from ischemic injury following mastectomy and can compromise immediate breast reconstruction. The tumescent mastectomy technique has been advocated as a method of allowing sharp dissection with decreased blood loss and perioperative analgesia. This study was performed to determine whether the technique increases the risk for skin flap necrosis in an immediate breast reconstruction setting.
  
  
  METHODS
  Three hundred eighty consecutive mastectomies with immediate reconstruction over a 6-year period were reviewed and divided into 2 cohorts for comparison: 100 tumescent and 280 nontumescent mastectomy cases. The incidence of minor and major skin flap necrosis was evaluated.
  
  
  RESULTS
  The use of tumescent mastectomy (odds ratio [OR], 3.93; P < .001), prior radiation (OR, 3.19; P = .011), patient age (OR, 1.59; P = .006), and body mass index (OR, 1.11; P = .004) were significant risk factors for developing postoperative major native skin flap necrosis.
  
  
  CONCLUSIONS
  The use of the tumescent mastectomy technique appears to be associated with a substantial increase in the risk for postoperative major skin flap necrosis in an immediate breast reconstruction setting.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Faulkner Hospital, Boston, MA, USA. ychun@partners.org
authors.forename: Yoon S
authors.initials: YS
authors.lastname: Chun
authors.forename: Kapil
authors.initials: K
authors.lastname: Verma
authors.forename: Heather
authors.initials: H
authors.lastname: Rosen
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Karl
authors.initials: K
authors.lastname: Breuing
authors.forename: Lifei
authors.initials: L
authors.lastname: Guo
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
authors.forename: Nareg
authors.initials: N
authors.lastname: Grigorian
authors.forename: Elof
authors.initials: E
authors.lastname: Eriksson
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods*; D008499:Medical Records; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D016017:Odds Ratio; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000098:blood supply*; D012907:Smoking / Q000009:adverse effects; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome