{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T14:45:50Z","timestamp":1764859550641},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Mastectomy skin flap necrosis (MSFN) is a common complication following mastectomy that causes significant distress to patients and physicians and also compromises oncologic, surgical, and quality-of-life outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We sought to investigate the long-term outcomes of MSFN following implant-based reconstruction (IBR) and determine the rates and predictors of post-MSFN complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a 20-year analysis of consecutive adult (&amp;gt;18 years) patients who developed MSFN following mastectomy and IBR from January 2001 to January 2021. Multivariable analyses were performed to identify factors associated with post-MSFN complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 148 reconstructions, with a mean follow-up time of 86.6 \u00b1 52.9 months. The mean time from reconstruction to MSFN was 13.3 \u00b1 10.4 days, and most cases (n = 84, 56.8%) were full-thickness injuries. Most cases (63.5%) were severe, 14.9% were moderate, and 21.6% were mild. Forty-six percent (n = 68) developed a breast-related complication, with infection being the most common (24%). An independent predictor of overall complications was longer time from reconstruction to MSFN (odds ratio [OR], 1.66; P = .040). Aging was an independent predictor of overall complications (OR, 1.86; P = .038); infection (OR, 1.72; P = .005); and dehiscence (OR, 6.18; P = .037). Independent predictors of dehiscence were longer interval from reconstruction to MSFN (OR, 3.23; P = .018) and larger expander\/implant size (OR, 1.49; P = .024). Independent predictors of explantation were larger expander\/implant size (OR, 1.20; P = .006) and nipple-sparing mastectomy (OR, 5.61; P = .005).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>MSFN is associated with high risk of complications following IBR. Awareness of the timing and severity of MSFN and the predictors of post-MSFN complications is crucial for guiding evidence-based decision-making and improving outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of Evidence: 4<\/jats:title>\n                  <jats:p \/>\n               <\/jats:sec>","DOI":"10.1093\/asj\/sjad218","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T11:47:40Z","timestamp":1689076060000},"page":"NP898-NP907","source":"Crossref","is-referenced-by-count":3,"title":["The Skin Necrosis Conundrum: Examining Long-term Outcomes and Risk Factors in Implant-Based Breast Reconstruction"],"prefix":"10.1093","volume":"43","author":[{"given":"Abbas M","family":"Hassan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra M","family":"Elias","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huan T","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas A","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babak J","family":"Mehrara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles E","family":"Butler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesse C","family":"Selber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"issue":"6","key":"2023101319145666400_sjad218-B1","doi-asserted-by":"publisher","first-page":"438","DOI":"10.3322\/caac.21583","article-title":"Breast cancer statistics, 2019","volume":"69","author":"DeSantis","year":"2019","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"2023101319145666400_sjad218-B2","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1001\/jamasurg.2014.2895","article-title":"Nationwide trends in mastectomy for early-stage breast cancer","volume":"150","author":"Kummerow","year":"2015","journal-title":"JAMA Surg"},{"key":"2023101319145666400_sjad218-B3","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.breast.2017.12.010","article-title":"Addressing the paradox of increasing mastectomy rates in an era of de-escalation of therapy: communication strategies","volume":"38","author":"Tan","year":"2018","journal-title":"Breast"},{"key":"2023101319145666400_sjad218-B4","doi-asserted-by":"publisher","author":"Hassan","DOI":"10.1097\/prs.0000000000010345"},{"key":"2023101319145666400_sjad218-B5","doi-asserted-by":"publisher","author":"Hassan","DOI":"10.1097\/prs.0000000000010489"},{"issue":"Supplement_1","key":"2023101319145666400_sjad218-B6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/asj\/sjac116","article-title":"Aesthetic Plastic Surgery National Databank Statistics 2020\u20132021","volume":"42","year":"2022","journal-title":"Aesthet Surg J"},{"key":"2023101319145666400_sjad218-B7","doi-asserted-by":"publisher","first-page":"141","DOI":"10.2147\/bctt.S81712","article-title":"Mastectomy skin flap necrosis: challenges and solutions","volume":"9","author":"Robertson","year":"2017","journal-title":"Breast Cancer (Dove Med Press)"},{"issue":"2","key":"2023101319145666400_sjad218-B8","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1097\/PRS.0b013e3181aee9a3","article-title":"Salvage of tissue expander in the setting of mastectomy flap necrosis: a 13-year experience using timed excision with continued expansion","volume":"124","author":"Antony","year":"2009","journal-title":"Plast Reconstr Surg"},{"issue":"6","key":"2023101319145666400_sjad218-B9","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1016\/j.amjsurg.2005.08.019","article-title":"Total skin-sparing mastectomy without preservation of the nipple-areola complex","volume":"190","author":"Margulies","year":"2005","journal-title":"Am J Surg"},{"issue":"1","key":"2023101319145666400_sjad218-B10","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1097\/SLA.0b013e31818e41a7","article-title":"Total skin-sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients","volume":"249","author":"Garwood","year":"2009","journal-title":"Ann Surg"},{"issue":"10","key":"2023101319145666400_sjad218-B11","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1002\/bjs.5815","article-title":"Late results of skin-sparing mastectomy followed by immediate breast reconstruction","volume":"94","author":"Meretoja","year":"2007","journal-title":"Br J Surg"},{"issue":"1","key":"2023101319145666400_sjad218-B12","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1245\/s10434-015-4709-7","article-title":"Skin flap necrosis after mastectomy with reconstruction: a prospective study","volume":"23","author":"Matsen","year":"2016","journal-title":"Ann Surg Oncol"},{"issue":"8146","key":"2023101319145666400_sjad218-B13","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1016\/s0140-6736(79)92127-5","article-title":"Psychological response to breast cancer: effect on outcome","volume":"2","author":"Greer","year":"1979","journal-title":"Lancet"},{"issue":"4","key":"2023101319145666400_sjad218-B14","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1002\/micr.22081","article-title":"Quality of life before reconstructive breast surgery: a preoperative comparison of patients with immediate, delayed, and major revision reconstruction","volume":"33","author":"Rosson","year":"2013","journal-title":"Microsurgery"},{"issue":"3","key":"2023101319145666400_sjad218-B15","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1245\/s10434-012-2672-0","article-title":"Flap survival of skin-sparing mastectomy type IV: a retrospective cohort study of 75 consecutive cases","volume":"20","author":"Santanelli","year":"2013","journal-title":"Ann Surg Oncol"},{"key":"2023101319145666400_sjad218-B16","doi-asserted-by":"publisher","author":"Hassan","DOI":"10.1097\/prs.0000000000010817"},{"issue":"2","key":"2023101319145666400_sjad218-B17","doi-asserted-by":"publisher","first-page":"247e","DOI":"10.1097\/prs.0000000000009289","article-title":"Implant-based breast reconstruction following infected device explantation: is a second attempt worth it?","volume":"150","author":"Asaad","year":"2022","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"2023101319145666400_sjad218-B18","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1097\/SAP.0b013e31823aee67","article-title":"Long-term reconstructive outcomes after expander-implant breast reconstruction with serious infectious or wound-healing complications","volume":"68","author":"Peled","year":"2012","journal-title":"Ann Plast Surg"},{"key":"2023101319145666400_sjad218-B19","doi-asserted-by":"publisher","author":"Hassan","DOI":"10.1245\/s10434-023-13470-y"},{"issue":"6","key":"2023101319145666400_sjad218-B20","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1097\/01.prs.0000117192.54945.88","article-title":"Delayed-immediate breast reconstruction","volume":"113","author":"Kronowitz","year":"2004","journal-title":"Plast Reconstr Surg"},{"issue":"11","key":"2023101319145666400_sjad218-B21","doi-asserted-by":"publisher","first-page":"e3217","DOI":"10.1097\/gox.0000000000003217","article-title":"Is tissue expansion worth it? Comparative outcomes of skin-preserving versus delayed autologous breast reconstruction","volume":"8","author":"Phillips","year":"2020","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"9596","key":"2023101319145666400_sjad218-B22","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/s0140-6736(07)61602-x","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"issue":"4","key":"2023101319145666400_sjad218-B23","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1097\/01.prs.0000232362.82402.e8","article-title":"A single surgeon's 12-year experience with tissue expander\/implant breast reconstruction. Part 1: A prospective analysis of early complications","volume":"118","author":"Cordeiro","year":"2006","journal-title":"Plast Reconstr Surg"},{"issue":"6","key":"2023101319145666400_sjad218-B24","doi-asserted-by":"publisher","first-page":"1886","DOI":"10.1097\/PRS.0b013e31817151c4","article-title":"Predicting complications following expander\/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk","volume":"121","author":"McCarthy","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"2023101319145666400_sjad218-B25","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1016\/j.bjps.2006.03.057","article-title":"Complications analysis of 266 immediate breast reconstructions","volume":"59","author":"Pinsolle","year":"2006","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"5","key":"2023101319145666400_sjad218-B26","doi-asserted-by":"publisher","first-page":"858e","DOI":"10.1097\/prs.0000000000008983","article-title":"Defining mastectomy skin flap necrosis: a systematic review of the literature and a call for standardization","volume":"149","author":"Oleck","year":"2022","journal-title":"Plast Reconstr Surg"},{"issue":"2","key":"2023101319145666400_sjad218-B27","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1097\/01.prs.0000246379.99318.74","article-title":"A prospective assessment of surgical risk factors in 400 cases of skin-sparing mastectomy and immediate breast reconstruction with implants to establish selection criteria","volume":"119","author":"Woerdeman","year":"2007","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"2023101319145666400_sjad218-B28","doi-asserted-by":"publisher","first-page":"426","DOI":"10.4048\/jbc.2013.16.4.426","article-title":"Synergistic interactions with a high intraoperative expander fill volume increase the risk for mastectomy flap necrosis","volume":"16","author":"Khavanin","year":"2013","journal-title":"J Breast Cancer"},{"issue":"2","key":"2023101319145666400_sjad218-B29","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.amjsurg.2009.12.011","article-title":"Use of tumescent mastectomy technique as a risk factor for native breast skin flap necrosis following immediate breast reconstruction","volume":"201","author":"Chun","year":"2011","journal-title":"Am J Surg"},{"issue":"1","key":"2023101319145666400_sjad218-B30","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3233\/bd-2002-16107","article-title":"Impact of radiotherapy and chemotherapy on planning and outcome of breast reconstruction","volume":"16","author":"Agarwal","year":"2002","journal-title":"Breast Dis"},{"issue":"3","key":"2023101319145666400_sjad218-B31","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1097\/01.sap.0000046784.70583.e1","article-title":"Skin-sparing mastectomy flap complications after breast reconstruction: review of incidence, management, and outcome","volume":"50","author":"Hultman","year":"2003","journal-title":"Ann Plast Surg"},{"issue":"6","key":"2023101319145666400_sjad218-B32","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1097\/sap.0000000000000262","article-title":"Predictors of mastectomy flap necrosis in patients undergoing immediate breast reconstruction: a review of 718 patients","volume":"76","author":"Abedi","year":"2016","journal-title":"Ann Plast Surg"},{"issue":"3","key":"2023101319145666400_sjad218-B33","doi-asserted-by":"publisher","first-page":"330e","DOI":"10.1097\/PRS.0b013e31829ace49","article-title":"Impact of surgical techniques, biomaterials, and patient variables on rate of nipple necrosis after nipple-sparing mastectomy","volume":"132","author":"Gould","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"7","key":"2023101319145666400_sjad218-B34","doi-asserted-by":"publisher","first-page":"2265","DOI":"10.1097\/00006534-200206000-00015","article-title":"Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study","volume":"109","author":"Alderman","year":"2002","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"2023101319145666400_sjad218-B35","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1097\/PRS.0b013e31820436fa","article-title":"Effect of intraoperative saline fill volume on perioperative outcomes in tissue expander breast reconstruction","volume":"127","author":"Crosby","year":"2011","journal-title":"Plast Reconstr Surg"},{"issue":"9","key":"2023101319145666400_sjad218-B36","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1001\/archsurg.139.9.988","article-title":"Immediate breast reconstruction after mastectomy increases wound complications: however, initiation of adjuvant chemotherapy is not delayed","volume":"139","author":"Mortenson","year":"2004","journal-title":"Arch Surg"},{"issue":"1","key":"2023101319145666400_sjad218-B37","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.breast.2010.06.006","article-title":"Factors affecting post-operative complications following skin sparing mastectomy with immediate breast reconstruction","volume":"20","author":"Davies","year":"2011","journal-title":"Breast"},{"issue":"3","key":"2023101319145666400_sjad218-B38","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1097\/SAP.0b013e3181f9b20c","article-title":"Assessment of advanced age as a risk factor in microvascular breast reconstruction","volume":"67","author":"Chang","year":"2011","journal-title":"Ann Plast Surg"},{"issue":"5","key":"2023101319145666400_sjad218-B39","doi-asserted-by":"publisher","first-page":"302","DOI":"10.3109\/2000656x.2016.1170026","article-title":"Risk factors of mastectomy skin flap necrosis in immediate breast reconstruction using low abdominal flaps","volume":"50","author":"Lee","year":"2016","journal-title":"J Plast Surg Hand Surg"},{"issue":"1","key":"2023101319145666400_sjad218-B40","doi-asserted-by":"publisher","first-page":"e123","DOI":"10.1097\/sla.0000000000005386","article-title":"Development and assessment of machine learning models for individualized risk assessment of mastectomy skin flap necrosis","volume":"278","author":"Hassan","year":"2023","journal-title":"Ann Surg"}],"container-title":["Aesthetic Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjad218\/51171606\/sjad218.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/43\/11\/NP898\/52076680\/sjad218.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/43\/11\/NP898\/52076680\/sjad218.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T19:15:27Z","timestamp":1697224527000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/asj\/article\/43\/11\/NP898\/7222574"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,11]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,7,11]]},"published-print":{"date-parts":[[2023,10,13]]}},"URL":"https:\/\/doi.org\/10.1093\/asj\/sjad218","relation":{},"ISSN":["1090-820X","1527-330X"],"issn-type":[{"value":"1090-820X","type":"print"},{"value":"1527-330X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11]]},"published":{"date-parts":[[2023,7,11]]}}}