Management of Mastectomy Skin Necrosis in Implant Based Breast Reconstruction

Sue, Gloria R.; Long, Chao; Lee, Gordon K.

doi:10.1097/sap.0000000000001045

Cited by 29 publications

(35 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…Although DTI breast reconstruction is a preferred method of plastic surgeons, management of skin flap necrosis still presents a challenge [3,14]. Some studies have evaluated risk factors associated with postoperative complications of breast reconstruction [6,[14][15][16][17]. Smoking history, a high BMI ( ≥ 25 kg/m 2 ), immediate breast reconstruction, a nipple-sparing mastectomy, and diabetes have been identified as risk factors for skin flap necrosis [2,15,16,18].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A single-use negative-pressure wound therapy device can reduce mastectomy skin flap necrosis in direct-to-implant breast reconstruction

Kim

et al. 2020

Arch Aesthetic Plast Surg

View full text Add to dashboard Cite

A single-use negative-pressure wound therapy device can reduce mastectomy skin flap necrosis in direct-toimplant breast reconstruction INTRODUCTION Mastectomy skin flap necrosis is a challenging complication that makes wound management more difficult in patients who undergo breast reconstruction. Overall, the reported incidence of skin flap necrosis ranges from 1.5% to 41.2% of breast reconstruction cases [1]. A higher body mass index (BMI), use of immediate breast reconstruction, use of a nipple-sparing mastectomy, a history of smoking, hypertension, diabetes, or exposure to preoperative radiation, or some combination of these factors are correlated with an increased risk of skin flap necrosis [2]. Mastectomy skin flap necrosis requires wound treatment that

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A single-use negative-pressure wound therapy device can reduce mastectomy skin flap necrosis in direct-to-implant breast reconstruction

Kim

et al. 2020

Arch Aesthetic Plast Surg

View full text Add to dashboard Cite

show abstract

“…Several studies have evaluated factors relevant to ischemic complications associated with a mastectomy skin flap, such as mastectomy skin flap necrosis, after breast reconstruction. Established factors include a history of smoking, obesity, mastectomy specimen weight, and radiotherapy (27)(28)(29)(30)(31)(32)(33)(34). Anatomic factors such as skin flap thickness could potentially be associated with ischemic complications but they have rarely been studied.…”

Section: Discussionmentioning

confidence: 99%

Effect of contralateral augmentation on postoperative complications after the second stage of tissue expander/implant breast reconstruction

et al. 2020

View full text Add to dashboard Cite

Background: Contralateral augmentation mammoplasty in implant-based reconstruction could potentially lead to deterioration of the thickness of the mastectomy skin flap and increase postoperative complications of the reconstructed breast. We compared the complication rates of the reconstructed breast in the augmentation and no-augmentation groups among patients undergoing tissue expander/implant breast reconstruction.Methods: Patients who underwent mastectomy followed by tissue expander/implant breast reconstruction between February 2010 and April 2018 were retrospectively reviewed. The primary outcome measures were complications and the need for a revision operation. The augmentation and no-augmentation groups underwent propensity score-matched analysis and the matched cases underwent multivariable logistic regression analysis.Results: From the 234 patients in the augmentation group and 517 patients in the no-augmentation group, 200 propensity score-matched pairs were obtained. Analysis of the matched pairs revealed that the augmentation group as compared to the no-augmentation group showed a significantly higher overall complication rate (13.5 percent versus 6.5 percent; P=0.025) and revision operation rate (9.0 percent versus 3.0 percent; P=0.019). Multivariable conditional logistic regression analyses of the matched cases revealed that contralateral augmentation (odds ratio, 3.457; 95% confidence interval, 1.039-11.498; P=0.043) was associated with increased odds for a revision operation of the reconstructed breast.Conclusions: This study investigated the postoperative complications of the reconstructed breast associated with contralateral augmentation mammoplasty in patients who underwent mastectomy followed by tissue expander/implant breast reconstruction. The augmentation group had a higher revision operation rate than did the no-augmentation group. A clinical evaluation of the risks and benefits of contralateral augmentation and preoperative counseling may be indicated for patients who are undergoing implant-based breast reconstruction and are candidates for contralateral augmentation mammoplasty.

show abstract

“…Chemotherapy is often recommended only in patients with advanced disease stage [ 39 ]. Another complication of breast reconstruction is mastectomy-related skin flap necrosis that increases morbidity rates as it can lead to impaired wound healing, tissue scarring, infection, and ultimately implant removal and replacement [ 40 , 41 ]. Many of the clinical complication listed above are variations of failing normal tissue and repair processes and it seems important to briefly discuss similarities between normal wound healing and the FBR ( Figure 1 ).…”

Section: Clinical Complications With Implantsmentioning

confidence: 99%

Implant Fibrosis and the Underappreciated Role of Myofibroblasts in the Foreign Body Reaction

Noskovičová

Hinz

Pakshir

2021

Cells

View full text Add to dashboard Cite

Body implants and implantable medical devices have dramatically improved and prolonged the life of countless patients. However, our body repair mechanisms have evolved to isolate, reject, or destroy any object that is recognized as foreign to the organism and inevitably mounts a foreign body reaction (FBR). Depending on its severity and chronicity, the FBR can impair implant performance or create severe clinical complications that will require surgical removal and/or replacement of the faulty device. The number of review articles discussing the FBR seems to be proportional to the number of different implant materials and clinical applications and one wonders, what else is there to tell? We will here take the position of a fibrosis researcher (which, coincidentally, we are) to elaborate similarities and differences between the FBR, normal wound healing, and chronic healing conditions that result in the development of peri-implant fibrosis. After giving credit to macrophages in the inflammatory phase of the FBR, we will mainly focus on the activation of fibroblastic cells into matrix-producing and highly contractile myofibroblasts. While fibrosis has been discussed to be a consequence of the disturbed and chronic inflammatory milieu in the FBR, direct activation of myofibroblasts at the implant surface is less commonly considered. Thus, we will provide a perspective how physical properties of the implant surface control myofibroblast actions and accumulation of stiff scar tissue. Because formation of scar tissue at the surface and around implant materials is a major reason for device failure and extraction surgeries, providing implant surfaces with myofibroblast-suppressing features is a first step to enhance implant acceptance and functional lifetime. Alternative therapeutic targets are elements of the myofibroblast mechanotransduction and contractile machinery and we will end with a brief overview on such targets that are considered for the treatment of other organ fibroses.

show abstract

Management of Mastectomy Skin Necrosis in Implant Based Breast Reconstruction

Cited by 29 publications

References 16 publications

A single-use negative-pressure wound therapy device can reduce mastectomy skin flap necrosis in direct-to-implant breast reconstruction

A single-use negative-pressure wound therapy device can reduce mastectomy skin flap necrosis in direct-to-implant breast reconstruction

Effect of contralateral augmentation on postoperative complications after the second stage of tissue expander/implant breast reconstruction

Implant Fibrosis and the Underappreciated Role of Myofibroblasts in the Foreign Body Reaction

Contact Info

Product

Resources

About