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Effect on Timing of Free Flap Breast Reconstruction on Mastectomy Skin Necrosis
Shahnur Ahmed, MD, Jordan Crabtree, BS, Kasra N. Fallah, MD, Ethan J. Rinne, BA, Luci Hulsman, BS, Carla S. Fisher, MD, MBA, Ravinder Bamba, MD, Rachel M. Danforth, MD, Mary E. Lester, MD, Aladdin H. Hassanein MD, MMSc
Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN
2025-01-09
Presenter: Shahnur Ahmed, MD
Affidavit:
All of the work on this project represents the original work of the resident and co-authors.
Director Name: E. Matthew Ritter
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background:
Deep inferior epigastric perforator (DIEP) flap is a common autologous breast reconstruction option. DIEP flap may be performed on the day of mastectomy (immediate DIEP) or at a later date typically following placement of a tissue expander during mastectomy (delayed-immediate DIEP). Preparing internal mammary vessels and the microsurgical anastomoses involve prolonged retraction of the breast skin flaps, which can increase tension on acutely ischemic mastectomy skin. This study investigates whether DIEP flap timing has an effect on mastectomy skin necrosis.
Methods:
A single center study was performed of patients who underwent immediate or delayed DIEP flap reconstruction over a 3-year period. Patients were divided into two groups: Group I (immediate DIEP flap) and Group II (delayed-immediate DIEP with flap staged separate from mastectomy). Outcomes assessed were breast skin flap necrosis and management of skin flap necrosis.
Results:
The study included 106 patients (173 flaps) in Group I (49 patients, 80 flaps) and Group II (57 patients, 93 flaps). Mastectomy skin flap necrosis rates were 11.3% (9/80) for Group I compared to 2.2% (2/93) of Group II patients (p=0.025). Skin necrosis necessitating operative debridement was 7.5% (6/80) in Group I and 1.1% (1/93) in Group II (p=0.0499).
Conclusion:
Immediate DIEP flaps performed on the day of mastectomy have significantly higher risk of mastectomy skin necrosis. Patients may be counseled that another advantage of staging DIEP flap on a different day than mastectomy is to decrease the risk of mastectomy skin necrosis.
