Wednesday, November 6, 2002 - 8:24 AM

Skin-Sparing Mastectomy Flap Complications Following Breast Reconstruction: Incidence, Risk Factors, and Effect on Adjuvant Therapies

C. Scott Hultman, MD, Lynn Damitz, MD, Sumer Daiza, MD, David Ollila, MD, Nancy Klauber-DeMore, MD, William Cance, MD, Anthony Meyer, MD, PhD, and Benjamin Calvo, MD.

Introduction: Skin-sparing mastectomy (SSM) can improve the aesthetic and functional results of breast reconstruction, without compromising oncologic principles. However, SSM flap complications could potentially delay the initiation of adjuvant chemo-radiotherapy. The purpose of this study is to assess the incidence of SSM flap loss, identify risk factors for complications, and to determine the effect on timing of adjuvant therapies. Methods: We performed a retrospective analysis of 70 consecutive patients undergoing SSM and breast reconstruction, at a university teaching hospital. Charts were reviewed to determine patient demographics, medical history, management of complications, and short-term outcome. Patients with and without complications were compared using Studentís t test and chi-square analysis. P values <0.05 were assigned statistical significance. Results: From July 2000 to February 2002, 70 patients (mean age 48.9, range 24-73 years) underwent SSM and breast reconstruction (unilateral 41, bilateral 29) via TRAM flaps (n=27), latissimus flaps (n=25), and expander/implants (n=18). SSM flap complications occurred in 15 patients (21.4%) and included mild (n=3), moderate (n=7), and extensive (n=5) skin loss, resulting in 4 cases of dehiscence and 5 re-operations. SSM flap loss did not delay the delivery of adjuvant therapy (required in 8 of these patients) and did not result in any failed reconstructions. Age, cigarette use, previous breast cancer, prior irradiation, and type of reconstruction were not associated with SSM flap complications. Diabetes, however, was associated with SSM flap complications (p<0.01). Body mass index (BMI) was significantly greater for patients with SSM flap loss than those without SSM flap loss (30.1 vs 24.5, p<0.01). Conclusions: SSM flap complications are common following all types of breast reconstruction but do not necessarily delay the initiation of adjuvant chemo-radiotherapy. Patients with diabetes and elevated BMI are at increased risk for SSM flap loss. Despite the infrequent need for re-operation, SSM flap complications did not undermine the success of the reconstruction or jeopardize oncologic priorities.
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