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Management of Mastectomy Skin Flap Necrosis Following Immediate Implant-Based Reconstruction: An Early Intervention Strategy Improves Salvage
Alexey Markelov, Wendy Chen, Kenneth Shestak, Sameer Shakir
University of Pittsburgh Medical Center
2014-02-28
Presenter: Alexey Markelov
Affidavit:
This research project was completed by the residents under direct supervision of senior faculty member
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Implant-based breast reconstruction remains a popular and effective reconstructive technique following mastectomy for treatment or prophylaxis of breast cancer. Mastectomy flap necrosis remains one of the most frequent complications of this technique leading to an early implant failure. Our study compares different management strategies employed to deal with this complication at our institution.
We reviewed single surgeon experience in the last 4 years, with 251 consecutive patients who underwent immediate implant-based reconstruction. 9.1% of the patients (N=23) developed mastectomy skin flap necrosis. Our study identified important prognostic factors for implant salvage. Overall implant salvage rate in the cohort was 65%. In all cases of implant salvage, surgical intervention was performed within 10 days, whereas delay in operative management lead to significantly higher rates of implant loss. In 17.4% of the patients extent of the skin loss mandated tissue added strategy and reconstruction was salvaged with latissimus dorsi flap. Our experience shows, that new tissue introduction is essential in cases with skin necrosis more than 6 cm in vertical dimension.
Conclusion:
Implant salvage is the best option to preserve the form and size of the existing skin envelope. Delay in surgical intervention in patients with mastectomy skin flap necrosis can lead to implant loss and reconstruction failure. Early intervention is the key to implant salvage especially in a face of infection or impending biological mesh or implant exposure. In cases of extensive skin necrosis, reducing the implant size and introducing new tissue as a flap increases the success rate of implant salvage.
