From the Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System.
Virginia Commonwealth University School of Medicine, Richmond, VA.
Ann Plast Surg. 2022 Jun 1;88(5 Suppl 5):S403-S409. doi: 10.1097/SAP.0000000000003164.
Mastectomy skin flap necrosis (MSFN) can significantly impact outcome after immediate breast reconstruction. Several techniques exist to predict MSFN, but these may require additional testing and information, and they are often not available before surgery. We aim to identify whether breast volume, as calculated from preoperative mammography, can be used as a preoperative predictor of MSFN.
A retrospective chart review from 2010 to 2020 resulted in 378 patients who underwent immediate implant-based breast reconstruction. Complete imaging data were available for 278 patients and 441 reconstructed breasts. Demographic, perioperative, and outcomes data were collected. Measurements from preoperative diagnostic mammograms were used to calculate breast volume. Univariate and multivariate analyses were used to evaluate the association of variables available preoperatively, including breast volume from mammogram and MSFN. Secondary analyses were performed for need for reoperation and loss of reconstruction.
On univariate analysis of MSFN development, demographic variables found to be significantly associated with MSFN included body mass index (P = 0.04), diabetes (P = 0.03), and breast volume calculated from routine mammography (P ≤ 0.0001). Average preoperative breast volume via mammography without and with MSFN was 970.6 mL (95% confidence interval [CI], 908.9-1032.3) and 1298.3 mL (95% CI, 1140.0-1456.5) (P < 0.0001), respectively. Statistically significant intraoperative variables for MSFN development included prolonged operative time (P = 0.005), greater initial tissue expander fill volumes (P ≤ 0.001), and prepectoral implant location (P = 0.02). Higher initial tissue expander fill volumes in implant-based reconstructions were associated with increased rates of MSFN, 264.1 mL (95% CI, 247.2-281.0) without MSFN and 349.9 mL (95% CI, 302.0-397.8) in the group with MSFN, respectively (P < 0.001). On multivariate analysis, preoperative imaging volume (P = 0.02) was found to be significant, whereas body mass index and diabetes lost significance (P = 0.40) in association with MSFN.
The results of this study establish an association between larger breast volume on preoperative imaging and development of MSFN. This may be useful as a tool for more appropriate patient selection and guidance in the setting of immediate breast reconstruction.
即刻乳房重建后皮瓣坏死（MSFN）会显著影响治疗效果。目前有多种技术可以预测 MSFN，但这些技术可能需要额外的检查和信息，并且通常在手术前无法获得。我们旨在确定术前乳腺 X 线摄影计算的乳房体积是否可作为 MSFN 的术前预测指标。
对 2010 年至 2020 年的回顾性图表审查，纳入了 378 例接受即刻植入物乳房重建的患者。278 例患者和 441 个乳房重建均有完整的影像学数据。收集人口统计学、围手术期和结局数据。使用术前诊断性乳腺 X 线摄影术的测量值计算乳房体积。采用单变量和多变量分析评估术前变量（包括来自乳腺 X 线摄影术的乳房体积和 MSFN）与 MSFN 发展的相关性。对需要再次手术和重建丢失进行了二次分析。
在 MSFN 发生的单变量分析中，与 MSFN 显著相关的人口统计学变量包括体重指数（P = 0.04）、糖尿病（P = 0.03）和常规乳腺 X 线摄影术计算的乳房体积（P ≤ 0.0001）。无 MSFN 和有 MSFN 的术前乳腺 X 线摄影术平均乳房体积分别为 970.6 mL（95%置信区间 [CI]，908.9-1032.3）和 1298.3 mL（95% CI，1140.0-1456.5）（P < 0.0001）。与 MSFN 发展相关的术中统计学显著变量包括手术时间延长（P = 0.005）、初始组织扩张器填充量更大（P ≤ 0.001）和胸肌前植入物位置（P = 0.02）。植入物乳房重建中更高的初始组织扩张器填充量与 MSFN 的发生率增加相关，无 MSFN 组为 264.1 mL（95% CI，247.2-281.0），有 MSFN 组为 349.9 mL（95% CI，302.0-397.8）（P < 0.001）。多变量分析显示，术前影像学体积（P = 0.02）与 MSFN 相关，而体重指数和糖尿病（P = 0.40）与 MSFN 无关。
本研究结果确立了术前影像学上较大的乳房体积与 MSFN 发展之间的关联。这可能有助于更适当地选择患者，并为即刻乳房重建提供指导。
