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J Reconstr Microsurg
DOI: 10.1055/a-2540-1154
Original Article

Effect on Timing of Free Flap Breast Reconstruction on Mastectomy Skin Necrosis

Shahnur Ahmed 
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Jordan Crabtree
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Kasra N. Fallah
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Ethan J. Rinne
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Luci Hulsman
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Carla S. Fisher
2   Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Kandice K. Ludwig
2   Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Rachel M. Danforth
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Mary E. Lester
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Aladdin H. Hassanein
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Funding None.
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Abstract

Background Deep inferior epigastric perforator (DIEP) flap is a common autologous breast reconstruction option. DIEP flap may be performed immediately on the day of mastectomy (immediate DIEP) or at a later date typically following placement of a tissue expander during mastectomy (delayed-immediate DIEP). Preparing internal mammary vessels during microsurgical anastomoses involves prolonged retraction of the breast skin flaps, which can increase tension on acutely ischemic mastectomy skin. The purpose of this study is to investigate whether DIEP flap timing has an effect on mastectomy skin necrosis.

Methods A single-center study was performed of patients who underwent immediate or delayed DIEP flap reconstruction over a 3-year period. Patients were divided into two groups: Group I (immediate DIEP flap) and Group II (delayed-immediate DIEP with flap staged separately from mastectomy). The outcomes assessed were breast skin flap necrosis and management of skin flap necrosis.

Results The study included 106 patients (173 flaps) in Group I (49 patients, 80 flaps) and Group II (57 patients, 93 flaps). Mastectomy skin flap necrosis rates were 11.3% (9/80) for Group I compared to 2.2% (2/93) of Group II patients (p = 0.025). Skin necrosis necessitating operative debridement was 7.5% (6/80) in Group I and 1.1% (1/93) in Group II (p = 0.0499).

Conclusion Immediate DIEP flaps performed on the day of mastectomy have a significantly higher risk of mastectomy skin necrosis. Patients may be counseled that another advantage of performing a DIEP flap on a different day than a mastectomy is to decrease the risk of mastectomy skin necrosis.

Keywords

deep inferior epigastric perforator - DIEP - mastectomy skin necrosis - free flap


Publikationsverlauf

Eingereicht: 29. Oktober 2024

Angenommen: 26. Januar 2025

Artikel online veröffentlicht:
11. März 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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