Delayed De-epithelialization of Reconstruction Flap as a Potential Salvage of Mastectomy Skin Flap Necrosis in Immediate Breast Reconstruction after Skin- or Nipple-Sparing Mastectomy

Abstract

Mastectomy skin flap necrosis (MSFN) is a well-known complication of skin- or nipple-sparing mastectomy with immediate reconstruction. Full-thickness loss of skin of the mastectomy flap often requires surgical debridement, subsequent exposure of the de-epithelialized flap, and skin graft, leading to a less than optimal cosmetic result. Delaying the de-epithelialization of the reconstruction flap as a secondary procedure until final demarcation of the mastectomy skin flap ensures good-quality vascular skin cover in cases of MSFN. A rim of skin from the reconstruction flap surrounding the required skin paddle was banked within the mastectomy skin flaps and de-epithelialized 1 week after the primary surgery. Six patients were included in this study. Two patients developed MSFN, hence underwent debridement and the skin from the reconstructed deep inferior epigastric artery perforator flap was used to cover the defect. The remaining four patients did not have MSFN and the excess skin of the reconstructed flap was de-epithelialized and the final inset completed. One patient who did not have MSFN developed seroma collection, which was treated conservatively. Delayed de-epithelialization of the reconstruction flap is a potential salvage procedure option, especially in cases where MSFN risk is higher. This procedure is a safe and simple step to ensure a good cosmetic result even after a complication like MSFN.