Page 70 - Read Online

Black et al. Plast Aesthet Res 2023;10:31 Plastic and
DOI: 10.20517/2347-9264.2023.04
Aesthetic Research

Review Open Access

Mitigating the impact of skin necrosis in
reconstruction after nipple-sparing mastectomy

#
#
Grant G. Black , Yunchan Chen , Marcos Lu Wang , Karina Condez, David M. Otterburn
Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY 10065, USA.
#
Authors contributed equally.
Correspondence to: Dr. David M. Otterburn, Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian/Weill
Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA. E-mail: dmo9004@med.cornell.edu
How to cite this article: Black GG, Chen Y, Wang ML, Condez K, Otterburn DM. Mitigating the impact of skin necrosis in
reconstruction after nipple-sparing mastectomy. Plast Aesthet Res 2023;10:31. https://dx.doi.org/10.20517/2347-9264.2023.04

Received: 17 Jan 2023 Revised: 22 May 2023 Accepted: 25 Jun 2023 Published: 28 Jun 2023
Academic Editor: Gordon Kwanlyp Lee Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Skin flap necrosis is a common postoperative complication after breast reconstruction, with an incidence of up to
43.4% among patients undergoing nipple-sparing mastectomy. Necrosis can adversely impact aesthetics due to
the need to excise nonviable tissue, and increase the risks of infection, implant loss, nipple-areola complex sacrifice
and malposition. Patient-specific factors including age, body mass index, and breast size may affect the risk of
necrosis. Mastectomy and reconstruction techniques (i.e., choosing between skin- and nipple-sparing mastectomy,
and between autologous and alloplastic reconstruction) may also influence necrosis rates. Intraoperative measures
such as indocyanine green angiography and autologous skin banking, and the postoperative use of nitroglycerin
paste for high-risk patients and warming blankets for autologous reconstruction are methods to help prevent and
minimize the morbidity of skin necrosis. Herein, we share our institution’s approaches to predicting and mitigating
skin necrosis, and methods of optimizing outcomes for breast reconstruction patients.

Keywords: Mastectomy, breast reconstruction, necrosis, autologous flap, implant

INTRODUCTION
Breast cancer is one of the most common forms of neoplasia in women; approximately 1 in 8 will develop it
[1]
in their lifetime . The number of mastectomies performed each year is rising both as a factor of the growing

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.parjournal.net