The Skin Necrosis Conundrum: Examining Long-term Outcomes and Risk Factors in Implant-Based Breast Reconstruction

Area of Science:

• Plastic Surgery
• Oncologic Surgery
• Reconstructive Surgery

Background:

• Mastectomy skin flap necrosis (MSFN) is a frequent complication post-mastectomy.
• MSFN negatively impacts oncologic, surgical, and quality-of-life outcomes.

Purpose of the Study:

• To investigate long-term outcomes of MSFN following implant-based reconstruction (IBR).
• To identify rates and predictors of post-MSFN complications.

Main Methods:

• A 20-year retrospective analysis (2001-2021) of adult patients undergoing mastectomy and IBR with MSFN.
• Multivariable analyses were used to identify factors associated with post-MSFN complications.

Main Results:

• 148 reconstructions analyzed with a mean follow-up of 86.6 months.
• Full-thickness injuries (56.8%) and severe MSFN (63.5%) were common.
• Complications occurred in 46% of cases, with infection (24%) most frequent. Predictors included time to MSFN, aging, dehiscence, explantation, larger implant size, and nipple-sparing mastectomy.

Conclusions:

• MSFN following IBR carries a high risk of complications.
• Understanding MSFN timing, severity, and predictors is vital for evidence-based decision-making and improved patient outcomes.