Strategies to avoid mastectomy skin-flap necrosis during nipple-sparing mastectomy.
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
12 06 2023
12 06 2023
Historique:
received:
24
11
2022
revised:
13
01
2023
accepted:
02
04
2023
pmc-release:
13
05
2024
medline:
3
7
2023
pubmed:
14
5
2023
entrez:
13
5
2023
Statut:
ppublish
Résumé
Nipple-sparing mastectomy is associated with a higher risk of mastectomy skin-flap necrosis than conventional skin-sparing mastectomy. There are limited prospective data examining modifiable intraoperative factors that contribute to skin-flap necrosis after nipple-sparing mastectomy. Data on consecutive patients undergoing nipple-sparing mastectomy between April 2018 and December 2020 were recorded prospectively. Relevant intraoperative variables were documented by both breast and plastic surgeons at the time of surgery. The presence and extent of nipple and/or skin-flap necrosis was documented at the first postoperative visit. Necrosis treatment and outcome was documented at 8-10 weeks after surgery. The association of clinical and intraoperative variables with nipple and skin-flap necrosis was analysed, and significant variables were included in a multivariable logistic regression analysis with backward selection. Some 299 patients underwent 515 nipple-sparing mastectomies (54.8 per cent (282 of 515) prophylactic, 45.2 per cent therapeutic). Overall, 23.3 per cent of breasts (120 of 515) developed nipple or skin-flap necrosis; 45.8 per cent of these (55 of 120) had nipple necrosis only. Among 120 breasts with necrosis, 22.5 per cent had superficial, 60.8 per cent had partial, and 16.7 per cent had full-thickness necrosis. On multivariable logistic regression analysis, significant modifiable intraoperative predictors of necrosis included sacrificing the second intercostal perforator (P = 0.006), greater tissue expander fill volume (P < 0.001), and non-lateral inframammary fold incision placement (P = 0.003). Modifiable intraoperative factors that may decrease the likelihood of necrosis after nipple-sparing mastectomy include incision placement in the lateral inframammary fold, preserving the second intercostal perforating vessel, and minimizing tissue expander fill volume.
Sections du résumé
BACKGROUND
Nipple-sparing mastectomy is associated with a higher risk of mastectomy skin-flap necrosis than conventional skin-sparing mastectomy. There are limited prospective data examining modifiable intraoperative factors that contribute to skin-flap necrosis after nipple-sparing mastectomy.
METHODS
Data on consecutive patients undergoing nipple-sparing mastectomy between April 2018 and December 2020 were recorded prospectively. Relevant intraoperative variables were documented by both breast and plastic surgeons at the time of surgery. The presence and extent of nipple and/or skin-flap necrosis was documented at the first postoperative visit. Necrosis treatment and outcome was documented at 8-10 weeks after surgery. The association of clinical and intraoperative variables with nipple and skin-flap necrosis was analysed, and significant variables were included in a multivariable logistic regression analysis with backward selection.
RESULTS
Some 299 patients underwent 515 nipple-sparing mastectomies (54.8 per cent (282 of 515) prophylactic, 45.2 per cent therapeutic). Overall, 23.3 per cent of breasts (120 of 515) developed nipple or skin-flap necrosis; 45.8 per cent of these (55 of 120) had nipple necrosis only. Among 120 breasts with necrosis, 22.5 per cent had superficial, 60.8 per cent had partial, and 16.7 per cent had full-thickness necrosis. On multivariable logistic regression analysis, significant modifiable intraoperative predictors of necrosis included sacrificing the second intercostal perforator (P = 0.006), greater tissue expander fill volume (P < 0.001), and non-lateral inframammary fold incision placement (P = 0.003).
CONCLUSION
Modifiable intraoperative factors that may decrease the likelihood of necrosis after nipple-sparing mastectomy include incision placement in the lateral inframammary fold, preserving the second intercostal perforating vessel, and minimizing tissue expander fill volume.
Identifiants
pubmed: 37178195
pii: 7161650
doi: 10.1093/bjs/znad107
pmc: PMC10517092
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
831-838Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Références
Ann Surg Oncol. 2019 Oct;26(10):3115-3123
pubmed: 31342370
Plast Reconstr Surg. 2019 May;143(5):906e-919e
pubmed: 30789474
Plast Reconstr Surg Glob Open. 2014 Sep 08;2(8):e198
pubmed: 25426381
Ann Surg Oncol. 2012 Apr;19(4):1137-44
pubmed: 21979111
Br J Surg. 2021 Apr 5;108(3):296-301
pubmed: 33793719
Ann Surg Oncol. 2016 Jan;23(1):257-64
pubmed: 26193963
Ann Surg Oncol. 2015 Sep;22(9):2925-32
pubmed: 25634782
Breast. 2020 Oct;53:85-91
pubmed: 32653836
Ann Surg Oncol. 2012 Oct;19(11):3402-9
pubmed: 22526909
Breast J. 2014 Jan-Feb;20(1):69-73
pubmed: 24224902
J Plast Reconstr Aesthet Surg. 2017 Feb;70(2):236-242
pubmed: 28040452
Plast Reconstr Surg. 2014 Mar;133(3):496-506
pubmed: 24572843
Ann Surg Oncol. 2013 Oct;20(10):3218-22
pubmed: 23975296
Ann Surg Oncol. 2020 Feb;27(2):344-351
pubmed: 31823173
Breast Cancer Res Treat. 2006 Mar;96(1):47-51
pubmed: 16261402
Br J Plast Surg. 1986 Jul;39(3):287-99
pubmed: 3730674
Plast Reconstr Surg. 2013 Sep;132(3):330e-338e
pubmed: 23985644
Ann Surg Oncol. 2014 Oct;21(10):3223-30
pubmed: 25052246
Plast Reconstr Surg. 2018 Jul;142(1):13-26
pubmed: 29878989
Ann Surg Oncol. 2013 Mar;20(3):981-9
pubmed: 23054113