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Skin Reducing Mastectomy and Immediate Tissue Expander Reconstruction: A Critical Analysis
Samuel H Payne1, Socorro Ballesteros, Owen H Brown
1From the Division of Plastic Surgery, Department of Surgery, Emory University; Atlanta, GA.
Annals of Plastic Surgery
|October 29, 2021
Summary
Skin reducing mastectomy (SRM) with a dermal flap is effective for breast reconstruction in obese patients, showing similar major complication rates to skin sparing mastectomy (SSM). While minor complications and mastectomy skin flap necrosis are more frequent with SRM, overall reconstructive success is comparable.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Oncologic Surgery
Background:
- Complications in implant-based breast reconstruction correlate with increased BMI and breast size.
- Skin reducing mastectomy (SRM) utilizes a dermal flap, and its impact on outcomes is under investigation.
Purpose of the Study:
- To evaluate the outcomes of skin reducing mastectomy (SRM) with a dermal flap compared to skin sparing mastectomy (SSM) in immediate submuscular tissue expander (TE) reconstruction.
- To identify risk factors for complications in SRM and assess the role of acellular dermal matrix (ADM).
Main Methods:
- Retrospective review of 162 patients (292 breasts) undergoing immediate TE reconstruction by a single surgeon (2011-2019).
- Comparison of outcomes between SRM (73 patients) and SSM (89 patients).
- Analysis included patient demographics, mastectomy characteristics, complication rates, and reconstructive failure.
Main Results:
- SRM patients had higher mean BMI (29.2 vs 25.9) and mastectomy weight (833.6g vs 425.6g) compared to SSM patients.
- Minor complications (22.8% vs 4.5%) and mastectomy skin flap necrosis (22.8% vs 7.7%) were more prevalent in the SRM group.
- Major complication rates (11.0% vs 10.9%) and reconstructive failure rates (5.9% vs 5.1%) were similar between SRM and SSM groups. Higher BMI (≥30) and mastectomy weight (≥800g) were risk factors for complications in SRM.
Conclusions:
- SRM with a dermal flap is a viable option for immediate TE reconstruction, even in obese patients with larger breasts, yielding similar major complication rates to SSM.
- While SRM is associated with increased minor complications and mastectomy skin flap necrosis, the dermal flap effectively covers the tissue expander, preventing exposure and seroma.
- The use of acellular dermal matrix (ADM) in SRM did not negatively impact complication rates and was associated with lower BMI and mastectomy weight in patients who received it.
