Mastectomy flap necrosis after nipple‐sparing mastectomy and immediate implant‐based reconstruction: An evaluation of tumescence and sharp dissection technique on surgical outcomes

Abstract

Nipple‐sparing mastectomy (NSM) with immediate implant‐based reconstruction has better esthetic outcomes and improved patient satisfaction, in addition to being oncologically safe. A known complication of NSM is skin flap necrosis. The use of tumescence and sharp dissection may decrease this complication compared to the standard NSM technique using electrocautery. This is a retrospective review of patients who underwent a NSM between 2014 and 2017 at a regional cancer center. Tumescence with sharp dissection was compared to electrocautery. The primary outcome was skin flap necrosis. The secondary outcomes were operative time and management of the complication. A total of 62 patients underwent a NSM with 116 breasts being operated on. Full‐thickness necrosis occurred more frequently in the standard electrocautery group (12.8%) compared to the tumescence and sharp dissection group (1.3%; P = 0.02). Partial‐thickness necrosis also occurred more frequently in the standard group (33.3%) compared to the sharp dissection group (13.0%; P = 0.01). The operative time was significantly shorter in the sharp dissection group with the mean (SD) time being 183.5 (48.9) minutes compared to the standard electrocautery group at 202.9 (33.8) minutes (P = 0.03). NSM using tumescence and sharp dissection have a lower rate of the complications of partial‐ and full‐thickness necrosis. Shorter operative time was also seen with the tumescent technique.

Complication Differences Between the Tumescent and Non-Tumescent Dissection Techniques for Mastectomy: A Meta-Analysis

“…Figure 1 shows the PRISMA flow-chart. We included nine studies in the review (15)(16)(17)(18)(19)(20)(21)(22)(23). Table 1 presents their characteristics.…”

Nipple-Sparing Mastectomy in Breast Cancer: Impact on Surgical Resection, Oncologic Safety, and Psychological Well-Being

“…In the 1990s, a technique was developed that used infiltration of the breast tissue with local anesthetic into the subcutaneous space to create a bloodless plan to dissect with scissors. This technique has been in use ever since ( Ng et al, 2019 ).…”

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

“…However, despite these clear anatomical descriptions indicating the importance of IMP preservation, the optimal surgical technique and success rate of IMP preservation during NSM, is not usually reported in clinical studies investigating the rate of ischemic complications following NSM [11][12][13][14]. Breast magnetic resonance imaging (MRI) with contrast, often obtained for preoperative oncologic assessment of tumor extent, or high-risk screening, can also demonstrate breast blood flow patterns with clinical relevance to ischemic complications [6].…”