Highlights
- •Mastectomy skin-flap necrosis (MSFN) after immediate implant-based breast reconstruction represents a dreaded complication, with a reported incidence up to 41%.
- •Preoperative techniques such as mammography, ultrasound, and MRI can provide useful information especially when combined together and compared with intraoperative findings.
- •Indocyanine angiography showed better prediction of MSFN than other intraoperative mastectomy flap assessment, however both thermal imaging and spectroscopy demonstrated novel and promising results.
Abstract
Mastectomy skin-flap necrosis (MSFN) is one of the most feared complications of immediate
implant-based breast reconstruction (IIBR). Traditionally, mastectomy skin-flap viability
was based only on surgeons’ clinical experience. Even though numerous studies have
already addressed the patients’ risk factors for MSFN, few works have focused on assessing
quality of breast envelope. This review investigates mastectomy's flap viability-assessment
methods, both preoperative (PMFA) and intraoperative (IMFA), to predict MSFN and its
sequalae. Between June and November 2022, we conducted a systematic review of Pubmed/MEDLINE
and Cochrane electronic databases. Only English studies regarding PMFA and IMFA applied
to IIBR were selected. The use of digital mammography, ultrasound, magnetic resonance
imaging, and a combination of several methods before surgery was shown to be advantageous
by several authors. Indocyanine performed better than other IMFA, however both thermal
imaging and spectroscopy demonstrated novel and promising results. Anyway, the best
prediction comes when preoperative and intraoperative values are combined. Particularly
in prepectoral reconstruction, when mastectomy flaps are essential to determine a
successful breast reconstruction, surgeons' clinical judgment is insufficient in assessing
the risk of MSFN. Preoperative and intraoperative assessment techniques play an emerging
key role in MSFN prediction. However, although there are several approaches to back
up the surgeon's processing choice, there is still a dearth of pertinent literature
on the subject, and more research is required.
Keywords
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Article info
Publication history
Published online: January 03, 2023
Accepted:
December 31,
2022
Received in revised form:
December 31,
2022
Received:
December 4,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
