A Comparative Analysis of Risk Factors for Breast Skin Necrosis Following Autologous versus Device-Based Breast Reconstruction.

Overview

abstract

BACKGROUND: Mastectomy skin flap necrosis often necessitates prolonged wound care, surgical re-excision, and increases the risk for infection. This study aims to compare rates of skin flap necrosis between autologous and device-based reconstructions and identify risk factors. METHODS: The authors retrospectively identified patients who underwent immediate breast reconstruction using either the deep inferior epigastric perforator flap (n = 373 breasts, 41 percent) or tissue expanders (n = 529 breasts, 59 percent) by two surgeons at a single institution between 2011 and 2021. The rate of skin flap necrosis between autologous and device-based reconstructions was compared and multivariate regression analysis was performed to identify risk factors. RESULTS: There was no significant difference in rates of skin flap necrosis between the two cohorts (26.8 percent versus 15.5 percent, p = 0.052). Across all patients, hypertension and body mass index > 30 were significant predictors of necrosis (p = 0.024 and p < 0.001, respectively). Within our DIEP cohort, mastectomy specimen weight was a significant risk factor for necrosis (p = 0.001). The DIEP flap weight itself does not confer a higher risk for necrosis (p = 0.8). CONCLUSIONS: Immediate autologous reconstruction does not place patients at higher risk of skin necrosis. Hypertension and obesity (body mass index > 30) were independent risk factors for necrosis in all patients. Mastectomy specimen weight was a significant predictor of necrosis in DIEP flap patients while the DIEP flap weight itself does not increase the risk for necrosis.