Retrospective Analyses of 75 consecutive skin sparing mastectomies type IV: risk factors and complications

Wise-pattern mastectomy is widely employed in women with medium-large and ptotic breasts, with in situ and early breast cancer or for prophylactic procedures. Many reports showed a high incidence of epidermolysis and full thickness necrosis of native skin flaps almost to 30% with delaying wounds healing and even threatening the success of reconstruction. Seventy-five consecutive immediate prosthetic reconstructions following Wise-pattern mastectomy on 63 patients were retrospectively analysed to assess risk factors for skin flaps ischemic complications and their impact on aesthetic outcomes and patients’ satisfaction. We investigated the influence of two clusters of hypothetic risk factors: patient-related (age, body mass index, smoke, neoadjuvant chemotherapy) and procedure-related (implant weight, breast weight, curative-prophylactic procedure, axillary lymph nodes dissection) by univariate and multivariate logistic regression analyses with Firth's bias correction. Significant risk factors from both analyses were considered as important selection criteria that expose the patients to higher risk of skin flaps ischemic complications. Moreover, patients were divided into 3 subgroups according to postoperative outcome: group A healed uneventfully, B with partial thickness and C with full thickness necrosis. Aesthetic evaluations scores of subgroups were analyzed and compared using a Kruskal-Wallis analysis of variance, and Dunn’s test for multiple comparisons between subgroups. From our statistical investigation smoking and weight of prosthesis >468g showed significant association with skin flaps ischemic complications, additionally analysis of aesthetic evaluations confirmed differences between subgroups (p=0.001), and multiple testing showed significance between subgroup A and C (p<0.05). In conclusion patients with clinically significant predictors are at higher risk of postoperative skin flaps ischemic complications and as a consequence less satisfied of their aesthetic outcomes. The surgeon should consider alternative procedures for such patients.