UNLABELLED: Skin sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is not only oncologically safe but provides also significant benefits both cosmetically and functionally. The superiority of this technique can only be fully established, however, by developing a framework for minimising complications. The present study seeks to elucidate the key factors affecting outcome. METHODS: Data for all skin sparing mastectomies with immediate autologous and implant based reconstructions, performed in a three year period (2006-2008) was retrospectively collated. Complications were classified into major and minor. Patients were excluded who had flap loss due to vascular complications. RESULTS: The total number analysed was 151. 17.2% had major complications, 23% had minor and 61% had no complications. The Wise and the "tennis" incision had significantly higher rates of wound dehiscence when compared with the periareolar incision (p = 0.025, p = 0.098). There was no significant difference between diathermy or blade dissection techniques, or the use of subcutaneous adrenaline infiltration. Increasing BMI was associated with increased skin flap necrosis and wound dehiscence, and an excised breast mass of greater than 750 g and a sternal notch to nipple length of greater than 26 cm are associated as well with increased flap-related complications (p = 0.0002, p = 0.0049). CONCLUSION: Factors such as Wise pattern and tennis racquet incision, BMI and breast mass and sternal notch to nipple length adversely affect skin sparing mastectomy flap morbidity. These factors should be factored in to patient selection and operative planning especially for obese and large breasted women undergoing skin sparing mastectomy with immediate breast reconstruction.
UNLABELLED: Skin sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is not only oncologically safe but provides also significant benefits both cosmetically and functionally. The superiority of this technique can only be fully established, however, by developing a framework for minimising complications. The present study seeks to elucidate the key factors affecting outcome. METHODS: Data for all skin sparing mastectomies with immediate autologous and implant based reconstructions, performed in a three year period (2006-2008) was retrospectively collated. Complications were classified into major and minor. Patients were excluded who had flap loss due to vascular complications. RESULTS: The total number analysed was 151. 17.2% had major complications, 23% had minor and 61% had no complications. The Wise and the "tennis" incision had significantly higher rates of wound dehiscence when compared with the periareolar incision (p = 0.025, p = 0.098). There was no significant difference between diathermy or blade dissection techniques, or the use of subcutaneous adrenaline infiltration. Increasing BMI was associated with increased skin flap necrosis and wound dehiscence, and an excised breast mass of greater than 750 g and a sternal notch to nipple length of greater than 26 cm are associated as well with increased flap-related complications (p = 0.0002, p = 0.0049). CONCLUSION: Factors such as Wise pattern and tennis racquet incision, BMI and breast mass and sternal notch to nipple length adversely affect skin sparing mastectomy flap morbidity. These factors should be factored in to patient selection and operative planning especially for obese and large breasted women undergoing skin sparing mastectomy with immediate breast reconstruction.
Authors: Mustafa Tukenmez; Burcu Celet Ozden; Orhan Agcaoglu; Mustafa Kecer; Vahit Ozmen; Mahmut Muslumanoglu; Abdullah Igci Journal: J Laparoendosc Adv Surg Tech A Date: 2014-01-08 Impact factor: 1.878
Authors: Elizabeth B Odom; Rajiv P Parikh; Grace Um; Simone W Kantola; Amy E Cyr; Julie A Margenthaler; Marissa M Tenenbaum; Terence M Myckatyn Journal: Plast Reconstr Surg Date: 2018-07 Impact factor: 4.730
Authors: Cindy B Matsen; Babak Mehrara; Anne Eaton; Deborah Capko; Anastasia Berg; Michelle Stempel; Kimberly J Van Zee; Andrea Pusic; Tari A King; Hiram S Cody; Melissa Pilewskie; Peter Cordeiro; Lisa Sclafani; George Plitas; Mary L Gemignani; Joseph Disa; Mahmoud El-Tamer; Monica Morrow Journal: Ann Surg Oncol Date: 2015-07-21 Impact factor: 5.344