Mitigating the impact of skin necrosis in reconstruction after nipple-sparing mastectomy

Abstract

Skin flap necrosis is a common postoperative complication after breast reconstruction, with an incidence of up to 43.4% among patients undergoing nipple-sparing mastectomy. Necrosis can adversely impact aesthetics due to the need to excise nonviable tissue, and increase the risks of infection, implant loss, nipple-areola complex sacrifice and malposition. Patient-specific factors including age, body mass index, and breast size may affect the risk of necrosis. Mastectomy and reconstruction techniques (i.e., choosing between skin- and nipple-sparing mastectomy, and between autologous and alloplastic reconstruction) may also influence necrosis rates. Intraoperative measures such as indocyanine green angiography and autologous skin banking, and the postoperative use of nitroglycerin paste for high-risk patients and warming blankets for autologous reconstruction are methods to help prevent and minimize the morbidity of skin necrosis. Herein, we share our institution’s approaches to predicting and mitigating skin necrosis, and methods of optimizing outcomes for breast reconstruction patients.

Keywords

Mastectomy / breast reconstruction / necrosis / autologous flap / implant

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