Factors related to necrosis at the T junction in reduction mammoplasty

Abstract

Background/Aim: Reduction mammoplasty is an effective and patient-satisfying operation in terms of relieving physical complaints such as back pain, shoulder collapse, and intertrigo due to macromastia. The most used incision is the wise pattern, which allows for easy intervention to the excess vertical and horizontal skin. However, long incisions may cause wound healing problems. The necessity of wide dissection may cause perfusion problems in the lateral and medial flaps at the T junction, where the tips of the flaps meet with the inframamarial sulcus. In the literature, T junction dehiscence is discussed under delayed healing complications. This study aimed to reveal the specific effects of the factors that were shown to cause delayed healing in general on the T junction area. Methods: In this retrospective cohort study, the effects of age, smoking habits, comorbidities, resection volume, and body mass index on T junction dehiscence were investigated among 56 patients who underwent reduction mammoplasty with wise pattern technique. The combined effects of all possible factors effective on dehiscence were investigated by multivariate logistic regression analysis. Results:The median age of the patients was 44.3 (12.5) years. Their mean body mass index was 26.0 (24.0-27.0) kg/m 2 , and 13% of the patients had comorbidities. The rate of dehiscence at the T junction was 28.6%. The most effective factors on the development of dehiscence were smoking and increased body mass index. Logistic regression analysis revealed that smoking increased the risk of T junction dehiscence by 8.543 times (95% Confidence Interval: 1.454-50.213) (P=0.018). No relationship was found between age, resection volume, comorbidities, and T junction dehiscence. Conclusion:The risk of dehiscence in the T junction increased in the patients who smoked and who had a high body mass index. The effect of smoking was much greater on T junction healing than its effect on general wound healing complications. T junction dehiscence should not be considered a delayed wound healing complication solely, but as a flap perfusion problem and preoperative measures should be taken accordingly.

Tension Reduction With Force Modulating Tissue Bridges Reduces Wounds in Breast Surgery

“… 5 A loss of closure integrity, variously described as wound dehiscence, delayed wound healing, wound separation, or an open wound, is perhaps the most common complication in benign elective breast surgeries such as mastopexy, augmentation-mastopexy, and reduction mammaplasty, with reported rates exceeding 20% in some studies. 6-8 Although often minor, wound dehiscence can be associated with more severe complications such as localized soft tissue infection, poor scar outcomes, and threatened or actual exposure of prosthetic materials including breast implants or support materials such as synthetic or biologic mesh.…”