Predicting Mastectomy Skin Flap Necrosis: A Systematic Review of Preoperative and Intraoperative Assessment Techniques

Pagliara, Domenico; Schiavone, Laurenza; Garganese, Giorgia; Bove, Sonia; Montella, Rino Aldo; Costantini, Melania; Bottosso, Stefano; Grieco, Federica; Rubino, Corrado; Salgarello, Marzia; Ribuffo, Diego

doi:10.1016/j.clbc.2022.12.021

Cited by 15 publications

(4 citation statements)

References 66 publications

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“…If perfusion was uncertain, indocyanine green angiography and a photodynamic eye camera (ICG-PDE imaging system) were employed as additional assessment tools before considering the patient not eligible for prepectoral reconstruction and planning a two-stage reconstruction. In fact, if compared to other tools such as thermal imaging and spectroscopy, ICG is still considered the best intraoperative mastectomy flap viability assessment method 38 .…”

Section: Discussionmentioning

confidence: 99%

The wide base bipedicled (WIBB) flap in nipple-sparing skin-reducing mastectomy

Cordova,

Rossi,

Roggio

et al. 2024

Sci Rep

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In this article, we present a modification of the NS/SRM technique in which the mastopexy design for skin reduction is undertaken with a wide-base bipedicled (WIBB) flap. The WIBB flap can be applied in both autologous and implant-based breast reconstruction. Our reconstructive algorithm is also presented. The clinical data of patients operated on from June 2017 to November 2022 were collected: 51 patients for a total of 71 breasts. Personal data, BMI, type and volume of implants used, and major and minor complications were analyzed by descriptive statistics. The mean age was 48.3 years. BMI ranged between 21.5 and 30.9 kg/m2. Thirty-one patients underwent unilateral mastectomy, while twenty patients underwent bilateral surgery. In 25 breasts, immediate reconstruction was performed with implants and ADM. In 40 breasts, reconstruction was performed with a subpectoral tissue expander, and in 6 breasts, reconstruction was performed with a DIEP flap. We observed only one case (1.4%) of periprosthetic infection requiring implant removal under general anesthesia. Minor complications occurred in 14.1% of patients. The use of both the WIBB flap and our algorithm maintained a low complication rate in our series, ensuring oncological radicality and a good aesthetic result at the same time.

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Section: Discussionmentioning

confidence: 99%

The wide base bipedicled (WIBB) flap in nipple-sparing skin-reducing mastectomy

Cordova,

Rossi,

Roggio

et al. 2024

Sci Rep

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“…Rates of mastectomy flap necrosis in the literature range from 4.5% to 41% based on recent a systematic review ( 57 ). Several factors have been identified as independent risk factors for mastectomy flap necrosis in patients undergoing implant-based breast reconstruction ( Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

Management of complications following implant-based breast reconstruction: a narrative review

Meshkin,

Firriolo,

Karp

et al. 2023

Ann Transl Med

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Background and Objective Complications associated with implant-based reconstruction have a spectrum of severity with sequelae ranging from mild aesthetic deformities to additional surgery, reconstructive failure and systemic illness. The purpose of this narrative review of the literature is to provide updated evidence-based information on the management of complications in implant-based reconstruction. Methods A systematic search of PubMed, OVID MEDLINE and the Cochrane Library databases was performed to identify common complications associated with implant-based breast reconstruction, incidences of occurrence as well as preventative and management strategies. Key Content and Findings Pertinent short and long-term complications of implant-based breast reconstruction include hematoma, implant infection, seroma, skin envelope necrosis, capsular contracture, rupture, malposition, animation and contour deformities, implant-associated anaplastic large cell lymphoma, and breast implant illness. Important preventative measures for short term complications include meticulous sterile technique and antibiotic irrigation, adequate drainage and critical evaluation of mastectomy flaps. Management of short-term complications requires early recognition and aggressive treatment to prevent reconstructive failure as well as long-term complications such as capsular contracture. Important technological advances include dual-port expanders for seroma drainage, indocyanine green angiography for mastectomy flap perfusion evaluation, cohesive form-stable implants for treatment of rippling, and various biologic and synthetic mesh products for pocket control and correction. Conclusions Important principles in management of short-term complications in implant-based reconstruction include aggressive and early intervention to maximize the chance of reconstructive salvage. Contemporary technological advances have played an important role in both prevention and treatment of complications. Over-arching principles in management of implant-based reconstruction complications focus on preventative techniques and preoperative patient counseling on potential risks, their likelihood, and necessary treatments to allow for informed and shared decision-making.

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“…Regardless of the technique employed for implant-based breast reconstruction, the most dreaded complication that surgeons encounter is mastectomy skin flap necrosis [ 5 , 24 ]. Therefore, the preservation of this subcutaneous layer and its vascular supply is crucial for the success of the surgery.…”

Section: Prepectoral Breast Reconstruction and Use Of Indocyanine Gre...mentioning

confidence: 99%

Current Global Trends in Prepectoral Breast Reconstruction

Taj,

Chandavarkar,

Vidya

2024

Medicina

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Implant-based breast reconstruction (IBBR) is the most frequently performed procedure for breast reconstruction following mastectomy, which involves the surgical placement of breast implants. The approach to breast reconstruction can be divided into two main categories, namely prepectoral breast reconstruction (PPBR) and subpectoral breast reconstruction (SPBR), based on the implant plan and placement technique. In recent years, there has been a significant surge in the popularity of prepectoral implant-based breast reconstruction, where the implants are positioned above the chest muscle, as opposed to beneath it in the subpectoral approach. However, despite this growing preference, there is a lack of comprehensive data regarding the national trends in the utilization of this technique, thus necessitating further investigation. This narrative review aims to ascertain the current global patterns linked to prepectoral breast reconstruction and elucidate the considerations surrounding patient and implant selection, reconstructive techniques, the utilization of meshes in prepectoral reconstruction, the ensuing outcomes and complications, the ramifications of radiotherapy, and the potential advantages of integrating fat infiltration into the implementation of this technique in breast reconstruction with a focus on published papers in last five years. Conclusion: Prepectoral breast reconstruction has emerged as an appropriate surgical option for individuals seeking breast reconstruction. This development can be attributed to the recent progress made in implant technology, which has significantly enhanced the outcomes of this procedure. Additionally, advancements in mastectomy techniques, autologous fat grafting, and the use of acellular dermal matrices (ADMs) have also played a vital role in improving the aesthetic results of prepectoral breast reconstruction. As a result, the significance and effectiveness of this technique in the field of breast reconstruction have been firmly established, making it an essential component of the overall armamentarium available to plastic surgeons for breast reconstruction purposes.

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Predicting Mastectomy Skin Flap Necrosis: A Systematic Review of Preoperative and Intraoperative Assessment Techniques

Cited by 15 publications

References 66 publications

The wide base bipedicled (WIBB) flap in nipple-sparing skin-reducing mastectomy

The wide base bipedicled (WIBB) flap in nipple-sparing skin-reducing mastectomy

Management of complications following implant-based breast reconstruction: a narrative review

Current Global Trends in Prepectoral Breast Reconstruction

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