1 Plastic and
Reconstructive Surgery - Most Popular Articles by Frey, Jordan
D.; Stranix, John T.; Chiodo, Michael V.; Alperovich, Michael; Ahn, Christina
Y.; Allen, Robert J.; Choi, Mihye; Karp, Nolan S.; Levine, Jamie P.
Background:
Free flap monitoring in autologous reconstruction after nipple-sparing
mastectomy remains controversial. The authors therefore examined outcomes in
nipple-sparing mastectomy with buried free flap reconstruction versus free flap
reconstruction incorporating a monitoring skin paddle. Methods: Autologous free
flap reconstructions with nipple-sparing mastectomy performed from 2006 to 2015
were identified. Demographics and operative results were analyzed and compared
between buried flaps and those with a skin paddle for monitoring. Results: Two
hundred twenty-one free flaps for nipple-sparing mastectomy reconstruction were
identified: 50 buried flaps and 171 flaps incorporating a skin paddle. The most
common flaps used were deep inferior epigastric perforator (64 percent),
profunda artery perforator (12.1 percent), and muscle-sparing transverse rectus
abdominis myocutaneous flaps (10.4 percent). Patients undergoing autologous
reconstructions with a skin paddle had a significantly greater body mass index
(p = 0.006). Mastectomy weight (p = 0.017) and flap weight (p < 0.0001) were
significantly greater in flaps incorporating a skin paddle. Comparing outcomes,
there were no significant differences in flap failure (2.0 percent versus 2.3
percent; p = 1.000) or percentage of flaps requiring return to the operating
room (6.0 percent versus 4.7 percent; p = 0.715) between groups. Buried flaps
had an absolute greater mean number of revision procedures per nipple-sparing
mastectomy (0.82) compared with the skin paddle group (0.44); however, rates of
revision procedures per nipple-sparing mastectomy were statistically equivalent
between the groups (p = 0.296). Conclusion: Although buried free flap
reconstruction in nipple-sparing mastectomy has been shown to be safe and
effective, the authors’ technique has evolved to favor incorporating a skin
paddle, which allows for clinical monitoring and can be removed at the time of
secondary revision. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
