Abstract: The Impact Of Total Skin-Sparing Mastectomy Incision Type On Reconstructive Complications Following Radiation Therapy (Plastic Surgery 2013)

Saturday, October 12, 2013: 1:55 PM

Anne Warren Peled, MD , University of California, San Francisco, San Francisco, CA

Hani Sbitany, MD , Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA

Cassandra Ligh, BS , University of California, San Francisco, San Francisco, CA

Laura J. Esserman, MD, MBA , Surgery, University of California, San Francisco, San Francisco, CA

Barbara Fowble, MD , Radiation Oncology, University of California, San Francisco, San Francisco, CA

Robert D. Foster, MD , Plastic and Reconstructive Surgery, University of California, San Francisco, San Francisco, CA

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INTRODUCTION:

Immediate expander-implant reconstruction following total skin-sparing mastectomy (TSSM) can provide excellent aesthetic outcomes for patients. However, postoperative ischemic complications can negatively impact reconstructive outcomes and, in severe cases, even lead to reconstructive failure, particularly in the setting of post-mastectomy radiation therapy (PMRT). The goal of this study is to determine if the development of ischemic complications after PMRT is impacted by TSSM incision selection.

METHODS:

A prospectively-collected database of patients undergoing TSSM and immediate breast reconstruction was queried for patients who underwent immediate two-staged expander-implant reconstruction and PMRT. Based on our hypothesis that patients with inframammary (IMF) incisions would be more likely to develop ischemic complications than those without incisions on the dependent portion of the breast, we divided our patient cohort into two groups, those with IMF incisions and those with other TSSM incisions (including periareolar, superolateral, and radial). Ischemic complication rates were compared between groups using chi-square analysis.

RESULTS:

Of 458 patients undergoing TSSM and immediate expander-implant reconstruction during the six-year period included in the analysis, 91 (19.9%) had PMRT. 62 patients (68.1%) had IMF incisions and 29 (31.9%) had other TSSM incisions (19 (20.9%) periareolar, 6 (6.6%) superolateral, and 4 (4.4%) radial). Mean follow-up was 2.9 years (range 0.8 – 6.6 years). Rates of mastectomy skin flap necrosis (3.2% vs. 6.9%, p = 0.4) following PMRT were not significantly higher in the IMF group. However, breakdown of the TSSM incision after PMRT occurred more frequently in the IMF group (19.3% vs. 6.9%, p = 0.1) and was more likely to lead to subsequent implant removal when incisional breakdown occurred (77% vs 0%, p = 0.03), despite attempts at implant salvage.

CONCLUSIONS:

Use of an inframammary incision for total skin-sparing mastectomy and immediate expander-implant reconstruction leads to higher rates of incisional breakdown after post-mastectomy radiation therapy. Multiple factors, including preoperative breast size, degree of breast ptosis, and likelihood of PMRT, should be considered in determining optimal TSSM incision and reconstructive options.

22414 The Impact Of Total Skin-Sparing Mastectomy Incision Type On Reconstructive Complications Following Radiation Therapy