Risk factors of mastectomy skin flap necrosis in immediate breast reconstruction using low abdominal flaps.
BACKGROUND
The purpose of this study was to determine the risk factors associated with mastectomy skin flap necrosis during immediate reconstruction with TRAM or DIEP flaps.


METHODS
This study reviewed 1116 cases of immediate breast reconstruction over 10 years. Patients ranged in age from 29-76 years (average = 45.1 years), and had an average follow-up period of 65.6 months. Thirteen factors (age, BMI (body mass index), smoking habits, diabetes ptosis grade, midclavicle-to-nipple distance, neoadjuvant chemotherapy, free or pedicled flap, mastectomy method, surgeon, stage, axillary dissection, mastectomy weight) known to be associated with mastectomy flap necrosis were retrospectively analysed. The odds ratios of the risk factors were calculated using logistic regression analyses.


RESULTS
Mastectomy skin flap necrosis occurred in 247 cases (22.1%). Univariate regression analysis showed that the odds ratio of age, BMI, ptosis grade, midclavicle-to-nipple distance, free flap, mastectomy method, surgeon, stage, and mastectomy weight were significant and the odds ratios determined using multivariate analysis were significant for mastectomy method, surgeon, and mastectomy weight.


CONCLUSIONS
During breast reconstruction using abdominal tissue, the independent risk factors that affect mastectomy skin flap necrosis include the mastectomy method, surgeon, and the weight of the mastectomy specimen. Awareness of the impact of each risk factor will lead to the modification and individualisation of surgical techniques and continually improve outcomes.
a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea ;
Taik Jong
TJ
Lee
a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea ;
Tae Suk
TS
Oh
a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea ;
Eun Key
EK
Kim
a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea ;
Hyunsuk
H
Suh
b Department of Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea ;
Sei Hyun
SH
Ahn
b Department of Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea ;
Byung Ho
BH
Son
b Department of Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea ;
Jong Won
JW
Lee
c Seoul Plastic Surgery Clinic , Gangneung , Gangwon-do , South Korea.
Jonghan
J
Cho
a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea ;
Jin Sup
JS
Eom
D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D017568:Rectus Abdominis / Q000637:transplantation*; D012307:Risk Factors; D013524:Surgical Flaps / Q000473:pathology*
Breast reconstruction; mastectomy skin flap necrosis; risk factor