Determinants of optimal mastectomy skin flap thickness

Abstract

The variable and unpredictable thickness of the breast subcutaneous layer means that a single specific universal thickness for mastectomy skin flaps cannot be recommended. It may be that the plane between the subdermal fat and breast parenchyma is a reasonable guide for mastectomy flap thickness, but this may not always correspond to a subcutaneous fascial layer.

Assessment of Patient Factors, Surgeons, and Surgeon Teams in Immediate Implant-Based Breast Reconstruction Outcomes

“…It has previously been suggested that a central problem of skin flap viability is the thickness of the skin flap. 15,30 Because of the retrospective nature of this work, we cannot establish causality between skin necrosis and the thickness of flaps. Furthermore, skin flap thickness may not be attributable to surgical technique.…”

“…Although it is known that mastectomy surgeons have different rates of skin necrosis and infection, this study is unique in comparing outcome endpoints between oncologic and plastic surgeons. [15][16][17][18] This study hypothesizes that surgeons and surgeon teams (oncologic and plastic surgeon pairs) influence outcomes and that specific endpoints such as skin necrosis and infection may be associated with the patient, surgeon, and surgeon team.…”

Trends and controversies in multidisciplinary care of the patient with breast cancer

“…There are limited data to support using reduction, mastopexy or other techniques in order to offer these procedures to women with larger or more ptotic breasts yet the oncologic safety should remain the priority (203, 204). As with any mastectomy, patient body habitus should determine the appropriate thickness of skin flap; however given the frequent thin nature and longer length of the mastectomy and nipple areolar flaps with this approach, gentle tissue handling is critical (205). Magnetic resonance imaging (MRI) has been proposed as an aid to guide flap thickness, but at present the data are not sufficient to recommend this practice (206).…”

Systematic review of methodologies used to assess mastectomy flap viability

“…Reported rates are as high as 30 per cent4. The challenge lies in complete removal of all breast tissue to ensure oncological safety, while leaving sufficient skin flap thickness to maintain skin viability5. The superficial plane of dissection between the subcutaneous fat and breast tissue has been found to be indistinct under microscopic examination in almost half of patients6, making it technically difficult, especially with the more limited field of view compared with that of conventional mastectomy.…”