LAUSR

Abstract Background  Mastectomy skin flap necrosis often necessitates prolonged wound care, surgical re-excision, and it increases the risk for infection. This study aims to compare rates of skin flap necrosis between autologous and device-based reconstructions and identify risk factors. Methods  The authors retrospectively identified patients who underwent immediate breast reconstruction using either the deep inferior epigastric perforator (DIEP) flap ( n  = 373 breasts, 41%) or tissue expanders ( n  = 529 breasts, 59%) by two surgeons at a single institution between 2011 and 2021. The rate of skin flap necrosis between autologous and device-based reconstructions was compared and multivariate regression analysis was performed to identify risk factors. Results  There was no significant difference in rates of skin flap necrosis between the two cohorts (26.8 vs. 15.5%, p  = 0.052). Across all patients, hypertension and body mass index >30 were significant predictors of necrosis ( p  = 0.024 and p <0.001, respectively). Within our DIEP cohort, mastectomy specimen weight was a significant risk factor for necrosis ( p  = 0.001). The DIEP flap weight itself did not confer a higher risk for necrosis ( p  = 0.8). Conclusion  Immediate autologous reconstruction does not place patients at higher risk of skin necrosis. Hypertension and obesity (body mass index >30) were independent risk factors for necrosis in all patients. Mastectomy specimen weight was a significant predictor of necrosis in DIEP flap patients while the DIEP flap weight itself did not increase the risk for necrosis.