Clinical science
Use of tumescent mastectomy technique as a risk factor for native breast skin flap necrosis following immediate breast reconstruction

This paper was presented at the Plastic Research Council 54th Annual Meeting and the American Society of Breast Surgeons 2008 Annual Meeting.
https://doi.org/10.1016/j.amjsurg.2009.12.011Get rights and content

Abstract

Background

Native breast skin flap necrosis is a complication that can result from ischemic injury following mastectomy and can compromise immediate breast reconstruction. The tumescent mastectomy technique has been advocated as a method of allowing sharp dissection with decreased blood loss and perioperative analgesia. This study was performed to determine whether the technique increases the risk for skin flap necrosis in an immediate breast reconstruction setting.

Methods

Three hundred eighty consecutive mastectomies with immediate reconstruction over a 6-year period were reviewed and divided into 2 cohorts for comparison: 100 tumescent and 280 nontumescent mastectomy cases. The incidence of minor and major skin flap necrosis was evaluated.

Results

The use of tumescent mastectomy (odds ratio [OR], 3.93; P < .001), prior radiation (OR, 3.19; P = .011), patient age (OR, 1.59; P = .006), and body mass index (OR, 1.11; P = .004) were significant risk factors for developing postoperative major native skin flap necrosis.

Conclusions

The use of the tumescent mastectomy technique appears to be associated with a substantial increase in the risk for postoperative major skin flap necrosis in an immediate breast reconstruction setting.

Section snippets

Methods

A retrospective medical record review was performed of 275 consecutive patients who underwent mastectomy with immediate breast reconstruction by 3 plastic surgeons at the Brigham and Women's Hospital and Faulkner Hospital between 2002 and 2008. The study methods and design were reviewed and approved by the institutional review board of Brigham and Women's Hospital/Faulkner Hospital. A total of 380 consecutive mastectomies with immediate breast reconstructions were performed during the 6-year

Results

A total of 275 consecutive patients underwent 170 unilateral and 105 bilateral mastectomies with immediate reconstruction, totaling 380 reconstructions during the 6-year period. Of these, 100 mastectomies were performed using the tumescent technique and 280 were performed without using the tumescent technique. There was no significant difference in patient characteristics between the tumescent mastectomy group and the nontumescent mastectomy group, including age, BMI, comorbidities, smoking

Comments

Use of the tumescent technique has been reported as advantageous in mastectomies for several reasons. Hydrodissection and overdistension with the tumescent fluid may provide tension within the breast to facilitate easier skin flap dissection while decreasing the need for electrocautery. Some surgeons believe that minimal use of electrocautery during mastectomy is important to avoid potential thermal injury to the skin flaps, which can lead in turn to necrosis, especially when the mastectomy

References (13)

  • A.L. Vinton et al.

    Wound complications after modified radical mastectomy compared with tylectomy with axillary dissection

    Am J Surg

    (1991)
  • M. Morrow et al.

    Modified radical mastectomy with knife technique

    Arch Surg

    (2002)
  • R.G. Worland

    Expanded utilization of the tumescent technique for mastectomy

    Plast Reconstr Surg

    (1996)
  • W.M. Oliver et al.

    Reliable assessment of skin flap viability using orthogonal polarization imaging

    Plast Reconstr Surg

    (2003)
  • A. Shoher et al.

    Mastectomy performed with scissors following tumescent solution injection

    J Surg Oncol

    (2003)
  • K.A. Lipshy et al.

    Complications of mastectomy and their relationship to biopsy technique

    Ann Surg Oncol

    (1996)
There are more references available in the full text version of this article.

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    The reported rates of skin necrosis after mastectomy with or without reconstruction vary considerably (5%–30%) owing to heterogeneity in defining necrosis, especially in minor cases.35,36 Risk factors for skin flap necrosis after mastectomy include older age, obesity, large breasts, hypertension, active smoking, sarcopenia, prior radiation treatment, incision placement, and tissue expander volume.36–38 Skin-sparing mastectomies are not associated with an increased risk of skin necrosis compared with conventional flat mastectomy.

  • Tumescent technique versus electrocautery mastectomy: A randomized controlled trial

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    The one study [15] which only included one type of reconstruction (skin-sparing mastectomies with immediate autologous micro-surgical reconstruction) was the only study to find a lower rate of flap necrosis in the tumescent group, although not significant (12.8% vs. 14.0%, p = 0.646). Two of the studies included in the meta-analysis [10,11] showed that advanced age, obesity, history of radiation and smoking also increased the risk of flap necrosis. Seth et al. noted that the majority of patients having tumescent breast complications had at least one other risk factor suggesting that other, more significant, preoperative risk factors contribute to the risk of developing complications.

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The first 2 authors contributed to this project equally.

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