title: Factors affecting post-operative complications following skin sparing mastectomy with immediate breast reconstruction.
abstract: Skin sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is not only oncologically safe but provides also significant benefits both cosmetically and functionally. The superiority of this technique can only be fully established, however, by developing a framework for minimising complications. The present study seeks to elucidate the key factors affecting outcome.
  
  
  METHODS
  Data for all skin sparing mastectomies with immediate autologous and implant based reconstructions, performed in a three year period (2006-2008) was retrospectively collated. Complications were classified into major and minor. Patients were excluded who had flap loss due to vascular complications.
  
  
  RESULTS
  The total number analysed was 151. 17.2% had major complications, 23% had minor and 61% had no complications. The Wise and the "tennis" incision had significantly higher rates of wound dehiscence when compared with the periareolar incision (p = 0.025, p = 0.098). There was no significant difference between diathermy or blade dissection techniques, or the use of subcutaneous adrenaline infiltration. Increasing BMI was associated with increased skin flap necrosis and wound dehiscence, and an excised breast mass of greater than 750 g and a sternal notch to nipple length of greater than 26 cm are associated as well with increased flap-related complications (p = 0.0002, p = 0.0049).
  
  
  CONCLUSIONS
  Factors such as Wise pattern and tennis racquet incision, BMI and breast mass and sternal notch to nipple length adversely affect skin sparing mastectomy flap morbidity. These factors should be factored in to patient selection and operative planning especially for obese and large breasted women undergoing skin sparing mastectomy with immediate breast reconstruction.
authors.affiliation: GKT Cancer Reconstructive Service, St.Thomas' Hospital, Westminster Bridge Road, London, UK. kerry.angeletti@gmail.com
authors.forename: Kerry
authors.initials: K
authors.lastname: Davies
authors.forename: Lyra
authors.initials: L
authors.lastname: Allan
authors.forename: Paul
authors.initials: P
authors.lastname: Roblin
authors.forename: David
authors.initials: D
authors.lastname: Ross
authors.forename: Jian
authors.initials: J
authors.lastname: Farhadi
mesh_terms: D015992:Body Mass Index; D001941:Breast Diseases / Q000209:etiology; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D015412:Mastectomy, Segmental / Q000009:adverse effects* / Q000379:methods; D009336:Necrosis / Q000209:etiology; D009929:Organ Size; D018579:Patient Selection; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects* / Q000473:pathology; D013529:Surgical Wound Dehiscence / Q000209:etiology