Prognosis of Implant-Based Breast Reconstruction After Mastectomy Flap Necrosis: Predictors of Failure and Salvage

Background: In the realm of implant-based breast reconstruction, mastectomy flap necrosis (MFN) is a prevalent yet grave complication that poses a threat to the stability of the inserted prosthesis. Although numerous investigations have scrutinized the risk factors for MFN development, few have delved into the aftermath, specifically implant failure or salvage. This study seeks to appraise the prognosis of the implanted prosthesis following MFN occurrence, as well as identify predictors of such outcomes. Methods: Among patients who underwent immediate implant-based reconstruction between 2010 and 2022, individuals with MFN development were identified and scrutinized regarding the fate of their prosthesis (salvaged/failed). Independent risk factors were identified using multivariable analyses and subgroup analyses accounting for diverse clinical settings. Results: Among a total of 3128 cases, 422 of MFN (194 partial, 228 full-thickness necrosis) were examined. Of them, 384 prostheses (91%) were salvaged, while 38 (9%) failed. Multivariate analysis revealed predictors of reconstruction failure included nipple-sparing mastectomy, larger skin excision, type of acellular dermal matrix used, previous radiotherapy, and full-thickness necrosis, while operation procedures, including type of operation and plane for prosthesis insertion (prepectoral/subpectoral), showed no significant associations. Risk factors differed by insertion plane, with obesity, larger skin excision, and previous radiation history significant in the prepectoral group, and only MFN degree influencing successful salvage in the subpectoral. Conclusions: This study sheds light on the importance of understanding the prognosis and potential predictors of implant failure/salvage following MFN, emphasizing the need for tailored approaches to minimize the risk of reconstruction failure. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.