Article ; Online: Impact of Incision Placement on Ischemic Complications in Microsurgical Breast Reconstruction.
Plastic and reconstructive surgery
2022 Volume 149, Issue 2, Page(s) 316–322
Abstract: Background: Nipple-sparing mastectomy is associated with greater patient satisfaction than non-nipple-sparing approaches. Although various nipple-sparing mastectomy incisions have been described, the authors hypothesized that incision location would ... ...
| Abstract | Background: Nipple-sparing mastectomy is associated with greater patient satisfaction than non-nipple-sparing approaches. Although various nipple-sparing mastectomy incisions have been described, the authors hypothesized that incision location would impact the rate and location of ischemic complications to the mastectomy skin flap. Methods: A prospectively maintained database was queried to identify patients who underwent nipple-sparing mastectomy with immediate microsurgical reconstruction with a minimum postoperative follow-up of 12 months. The impact of incision location on postoperative ischemic complications was investigated. Major complications were defined as those that required reexploration in the operating room or inpatient management; minor complications were amenable to outpatient management. Multivariable logistic and linear regression were performed to investigate risk factors for postoperative complications following breast reconstruction. Results: Eighty-seven patients met inclusion criteria. The following nipple-sparing mastectomy incisions were used: radial with a periareolar extension (39 percent), inframammary fold (31 percent), vertical with a periareolar extension (22 percent), vertical (6 percent), and radial (2 percent). Seven patients (8 percent) had major complications, whereas twenty-six patients (29.9 percent) developed minor postoperative complications. Inframammary fold incisions were associated with significantly greater rates of mastectomy skin flap necrosis (p = 0.002), whereas periareolar incisions were associated with significantly greater rates of postoperative nipple-areola complex necrosis (p = 0.04). Conclusions: The authors report a significant association between incision location and ischemic complications to the breast skin envelope in microsurgical breast reconstruction. The authors observed a significant association of inframammary fold and periareolar incisions with mastectomy skin flap and nipple-areola complex necrosis, respectively. Clinical question/level of evidence: Therapeutic, III. |
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| MeSH term(s) | Adult ; Aged ; Breast Neoplasms/surgery ; Humans ; Ischemia/etiology ; Mammaplasty/adverse effects ; Mammaplasty/methods ; Mastectomy, Subcutaneous ; Microsurgery ; Middle Aged ; Postoperative Complications/etiology ; Prospective Studies ; Surgical Flaps ; Young Adult |
| Language | English |
| Publishing date | 2022-01-25 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 208012-6 |
| ISSN | 1529-4242 ; 0032-1052 ; 0096-8501 |
| ISSN (online) | 1529-4242 |
| ISSN | 0032-1052 ; 0096-8501 |
| DOI | 10.1097/PRS.0000000000008770 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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