title: Does the Use of Incisional Negative-Pressure Wound Therapy Prevent Mastectomy Flap Necrosis in Immediate Expander-Based Breast Reconstruction?
abstract: BACKGROUND
  Mastectomy flap necrosis is one of the most common and significant complications in immediate expander-based breast reconstruction. Negative-pressure wound therapy is widely used for open wounds but is not commonly used for closed incisional wounds. However, the postoperative use of incisional negative-pressure wound therapy is demonstrated to reduce complication rates. The authors evaluate the incidence of mastectomy flap necrosis in patients with incisional negative-pressure wound therapy after immediate expander-based breast reconstruction compared with the incidence in patients with conventional dressing.
  
  
  METHODS
  A retrospective review was conducted to identify patients who underwent immediate expander-based breast reconstruction between January of 2010 and February of 2015 at a single institution. Patients were divided into a conventional dressing group and an incisional negative-pressure wound therapy group. Patient demographics, intraoperative findings, and complications were compared between the two groups.
  
  
  RESULTS
  A total of 228 breasts (206 patients) were included in this study. Of these, the incisional negative-pressure wound therapy group included 45 breasts (44 patients) and the conventional dressing group included 183 breasts (162 patients). The incisional negative-pressure wound therapy group had a lower overall complication rate (11.1 percent versus 27.9 percent; p = 0.019), overall mastectomy flap necrosis rate (8.9 percent versus 23.5 percent; p = 0.030), and major mastectomy flap necrosis rate (2.2 percent versus 13.7 percent; p = 0.031) compared with the conventional dressing group.
  
  
  CONCLUSIONS
  Incisional negative-pressure wound therapy reduced the incidence of mastectomy flap necrosis. This simple and reliable dressing technique can be effective in preventing mastectomy flap necrosis in immediate expander-based breast reconstruction.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Sun-June
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Sa-Ik
authors.initials: SI
authors.lastname: Bang
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Goo-Hyun
authors.initials: GH
authors.lastname: Mun
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Jai-Kyong
authors.initials: JK
authors.lastname: Pyon
mesh_terms: D018427:Breast Implants; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D009336:Necrosis / Q000517:prevention & control; D054843:Negative-Pressure Wound Therapy; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D015626:Tissue Expansion; D015625:Tissue Expansion Devices / Q000009:adverse effects