A Comparative Analysis of Risk Factors for Breast Skin Necrosis following Autologous versus Device-Based Breast Reconstruction.

Background:  Mastectomy skin flap necrosis often necessitates prolonged wound care, surgical re-excision, and it increases the risk for infection. This study aims to compare rates of skin flap necrosis between autologous and device-based reconstructions and identify risk factors.

Methods:  The authors retrospectively identified patients who underwent immediate breast reconstruction using either the deep inferior epigastric perforator (DIEP) flap ( = 373 breasts, 41%) or tissue expanders ( = 529 breasts, 59%) by two surgeons at a single institution between 2011 and 2021. The rate of skin flap necrosis between autologous and device-based reconstructions was compared and multivariate regression analysis was performed to identify risk factors.

Results:  There was no significant difference in rates of skin flap necrosis between the two cohorts (26.8 vs. 15.5%,  = 0.052). Across all patients, hypertension and body mass index >30 were significant predictors of necrosis ( = 0.024 and <0.001, respectively). Within our DIEP cohort, mastectomy specimen weight was a significant risk factor for necrosis ( = 0.001). The DIEP flap weight itself did not confer a higher risk for necrosis ( = 0.8).

Conclusion:  Immediate autologous reconstruction does not place patients at higher risk of skin necrosis. Hypertension and obesity (body mass index >30) were independent risk factors for necrosis in all patients. Mastectomy specimen weight was a significant predictor of necrosis in DIEP flap patients while the DIEP flap weight itself did not increase the risk for necrosis.