Impact of Incision Placement on Ischemic Complications in Microsurgical Breast Reconstruction

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.

Nipple Sparing Mastectomy Technique to Reduce Ischemic Complications: Preserving Important Blood Flow Based on Breast MRI

“…The limitations of this study are due to the relatively small sample size, which may have caused the inability to determine the impact of other factors such as BMI and RT on clinical outcomes. Possibly, the IMP‐NSM technique may change the previously described impact of these factors [11, 12, 14, 24, 25]. Future studies of NSM necrosis complications should describe management of the IMP as an important variable that can be modified to decrease necrosis.…”

Impact of Incision Placement on Ischemic Complications in Microsurgical Breast Reconstruction

“…We read with great interest the article by Tevlin et al that examined the effects of incision location on ischemic complications of the mastectomy skin envelope after NSM and microvascular breast reconstruction. 1 In a total of 146 reconstructions in 87 patients, the authors reported a significantly greater rate of mastectomy skin flap necrosis with IMF incisions, and a significant association of NAC necrosis with periareolar incisions. The authors should be commended on a meticulously designed study that importantly uses propensity score matching to further reinforce the data on these incision patterns as independent risk factors.…”