Does Fitzpatrick Score Predict Flap Loss? Microsurgical Breast Reconstruction Outcomes of Varying Skin Color

Abstract

Background: The aim of this study was to seek evidence that patients with darker Fitzpatrick score skin tones are more susceptible to flap loss due to unsalvaged vascular compromise in autologous flap breast reconstruction. Methods: This is a retrospective study conducted on patients who underwent any type of autologous flap breast reconstruction performed by the two senior authors at an academic center between January 2010 and December 2021. The sole primary outcome variable was flap loss. Patient skin tone was assessed using the Fitzpatrick scale on clinical photographs of patients. Results: A total of 1115 pateints underwent autologous flap breast reconstruction, of which only 56 met both exclusion and inclusion criteria with 58 individual breasts being included in the final study population. The most common race of subjects was White (n = 33; 56.9%) while the most common Fitzpatrick score skin tone was type II (n = 22; 37.9%). The Cochran-Armitage test of trend showed a statistically significant linear trend, P = 0.006, with darker Fitzpatrick score skin tones associated with a higher proportion of flap loss in patients who had vascular compromise. A logistic regression showed that none of the predictor variables were significant. Conclusions: Patients with darker Fitzpatrick skin tones were associated with flap loss after vascular compromise. To prevent flap loss in patients who have darker Fitzpatrick score skin tones, more aggressive flap monitoring should be taken into consideration in the immediate postoperative setting.

Buried Autologous Breast Reconstruction: Outcomes and Technical Considerations

“…Nursing staff have reported preferring the binary outcome of whether flow is present or not compared to the subjective assessment of skin paddles [ 11 ]. A subjective assessment of skin paddles can be challenging in non-Caucasian skin and, as such, is associated with a higher incidence of flap loss due to delayed flap salvage [ 30 ].…”

A Novel Method to Determine Patient Skin Type: The Skin Analyzer

“…Existing research on skin color in the field of plastic surgery has shown that it can be an important factor not only in health equity but also in the prevalence of disease, patient risk for certain conditions, and patient outcomes, 2,[16][17][18] but such investigations are hindered by difficulty collecting objective and consistent data on skin color. It has been reported that plastic surgery journals use significantly more images of white-skinned than dark-skinned individuals.…”

Considerations for the Use of Fitzpatrick Skin Type in Plastic Surgery Research

“…For example, one study found that patients with darker FST are more likely to experience flap loss following autologous flap breast reconstruction, potentially due to providers’ inability to notice skin changes in patients with darker FST. 2 …”

“…For example, one study found that patients with darker FST are more likely to experience flap loss following autologous flap breast reconstruction, potentially due to providers' inability to notice skin changes in patients with darker FST. 2 Effectively measuring skin tone is vital to conducting health disparities research and improving surgical outcomes. Given the difficulty of recording racial data in electronic health records, FST has become a commonly used proxy for race/ethnicity.…”