World Journal of Surgery

, Volume 43, Issue 3, pp 846–852 | Cite as

Risk Factors for Skin Flap Necrosis in Breast Cancer Patients Treated with Mastectomy Followed by Immediate Breast Reconstruction

  • Hiroki Ito
  • Takayuki Ueno
  • Hirotaka Suga
  • Tomohiro Shiraishi
  • Hirotsugu Isaka
  • Kentaro Imi
  • Kaisuke Miyamoto
  • Manami Tada
  • Yoshiharu Ishizaka
  • Shigeru ImotoEmail author
Original Scientific Report



Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) are the standard techniques for achieving a cosmetic outcome, but necrosis of a cutaneous flap including the nipple–areolar complex (NAC) is a serious complication. To analyze the risk factors for skin flap necrosis, we retrospectively evaluated a clinical database of breast cancer patients treated with mastectomy followed by immediate breast reconstruction.


Four hundred and twelve cases were consecutively recorded between 2006 and 2016. Body weight (BW), body mass index (BMI), distance from NAC to referent tumor, distance from overlying skin to the tumor and weight of breast resection (WBR) as measured in the operating theater were included in the statistical analysis.


NSM, SSM and total mastectomy were performed in 123 (30%), 96 (23%) and 193 cases (47%), respectively. A tissue expander was used in 379 cases (92%), a silicone implant in 8 (2%) and autologous breast reconstruction in 25 (6%). Skin flap necrosis was found in 7% of all cases and NAC necrosis in 13% of NSM cases. In a univariate analysis, BW, NSM and WBR were risk factors for skin flap necrosis, and BW, BMI and WBR were risk factors for NAC necrosis. In a multivariate analysis, NSM and WBR remained significant risk factors for skin flap necrosis, and WBR was a significant risk factor for NAC necrosis.


WBR is an important risk factor for skin flap necrosis. Especially, NAC necrosis should be considered for patients with large-volume breasts who undergo NSM and immediate breast reconstruction.



The first author would like to thank Dr. Ouellette Tomoyo, Director of Kaneko Clinic, for her clinical advice.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Hiroki Ito
    • 1
    • 4
  • Takayuki Ueno
    • 2
    • 4
  • Hirotaka Suga
    • 3
  • Tomohiro Shiraishi
    • 3
  • Hirotsugu Isaka
    • 4
  • Kentaro Imi
    • 4
  • Kaisuke Miyamoto
    • 4
  • Manami Tada
    • 4
  • Yoshiharu Ishizaka
    • 4
  • Shigeru Imoto
    • 4
    Email author
  1. 1.Department of Breast SurgeryKaneko ClinicKagoshimaJapan
  2. 2.Breast Surgical Oncology, Breast Oncology Center, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
  3. 3.Department of Plastic SurgeryKyorin University School of MedicineMitaka, TokyoJapan
  4. 4.Department of Breast SurgeryKyorin University School of MedicineMitaka, TokyoJapan

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