Factors related to necrosis at the T junction in reduction mammoplasty

Authors

Keywords:

Wise pattern, T junction, Perfusion, Smoking, Wound healing

Abstract

Backgrounds/Aim: Reduction mammoplasty is an effective and patient-satisfying operation in terms of relieving physical complaints such as back pain, shoulder collapse, and intertrigo due to macromastia. The most used incision is the wise pattern, which allows for easy intervention to the excess vertical and horizontal skin. However, long incisions may cause wound healing problems. The necessity of wide dissection may cause perfusion problems in the lateral and medial flaps at the T junction, where the tips of the flaps meet with the inframamarial sulcus. In the literature, T junction dehiscence is discussed under delayed healing complications. This study aimed to reveal the specific effects of the factors that were shown to cause delayed healing in general on the T junction area. Methods: In this retrospective cohort study, the effects of age, smoking habits, comorbidities, resection volume, and body mass index on T junction dehiscence were investigated among 56 patients who underwent reduction mammoplasty with wise pattern technique. The combined effects of all possible factors effective on dehiscence were investigated by multivariate logistic regression analysis. Results: The median age of the patients was 44.3 (12.5) years. Their mean body mass index was 26.0 (24.0-27.0) kg/m2, and 13% of the patients had comorbidities. The rate of dehiscence at the T junction was 28.6%. The most effective factors on the development of dehiscence were smoking and increased body mass index. Logistic regression analysis revealed that smoking increased the risk of T junction dehiscence by 8.543 times (95% Confidence Interval: 1.454-50.213) (P=0.018). No relationship was found between age, resection volume, comorbidities, and T junction dehiscence. Conclusion: The risk of dehiscence in the T junction increased in the patients who smoked and who had a high body mass index. The effect of smoking was much greater on T junction healing than its effect on general wound healing complications. T junction dehiscence should not be considered a delayed wound healing complication solely, but as a flap perfusion problem and preoperative measures should be taken accordingly.

Downloads

Download data is not yet available.

References

Noone RB. An evidence-based approach to reduction mammaplasty. Plast Reconstr Surg. 2010;126:2171-6. doi: 10.1097/PRS.0b013e3181f830d7.

Schrenk P, Wölfl S, Bogner S, Huemer GM, Wayand W. Symmetrization reduction mammaplasty combined with sentinel node biopsy in patients operated for contra lateral breast cancer. J Surg Oncol. 2006;94:9-15. doi: 10.1002/jso.20542.

Antony AK, Yegiyants SS, Danielson KK, Wisel S, Morris D, Dolezal RF, et al. A matched cohort study of superomedial pedicle vertical scar breast reduction (100 breasts) and traditional inferior pedicle Wise-pattern reduction (100 breasts): an outcomes study over 3 years. Plast Reconstr Surg. 2013;132:1068-76. doi: 10.1097/PRS.0b013e3182a48b2d.

Khalil HH, Malahias M, Shetty G. Triangular lipoder malflaps in Wise pattern reduction mammoplasty (superomedial pedicle): A novel technique to reduce T-junction necrosis. PlastSurg (Oakv). 2016;24:191-4. doi: 10.4172/plastic-surgery.1000975.

Toplu G, Altınel D, Serin M. Evaluation of Factors Related to Postoperative Complications in Patients Who Underwent Reduction Mammoplasty. Eur J Breast Health. 2021;17:157-64. doi: 10.4274/ejbh.galenos.

Fischer JP, Cleveland EC, Shang EK, Nelson JA, Serletti JM. Complications following reduction mammaplasty: a review of 3538 cases from the 2005-2010 NSQIP datasets. Aesthet Surg J. 2014;34:66-73. doi: 10.1177/1090820X13515676.

Zhang MX, Chen CY, Fang QQ, Xu JH, Wang XF, Shi BH, et al . Risk Factors for Complications after Reduction Mammoplasty: A Meta-Analysis. PLoS One. 2016;11:e0167746. doi: 10.1371/journal.pone.0167746.

Srinivasaiah N, Iwuchukwu OC, Stanley PR, Hart NB, Platt AJ, Drew PJ. Risk factors for complications following breast reduction: results from a randomized control trial. Breast J. 2014;20:274-8. doi: 10.1111/tbj.12256

Simpson AM, Donato DP, Kwok AC, Agarwal JP. Predictors of complications following breast reduction surgery: A National Surgical Quality Improvement Program study of 16,812 cases. J Plast Reconstr Aesthet Surg. 2019;72:43-51. doi: 10.1016/j.bjps.2018.09.002..

Zubowski R, Zins JE, Foray-Kaplon A, Yetman RJ, Lucas AR, Papay FA, et al. Relationship of obesity and specimen weight to complications in reduction mammaplasty. Plast Reconstr Surg. 2000;106:998-1003. doi: 10.1097/00006534-200010000-00006.

Chan LK, Withey S, Butler PE. Smoking and wound healing problems in reduction mammaplasty: is the introduction of urine nicotine testing justified? Ann Plast Surg. 2006;56:111-5. doi: 10.1097/01.sap.0000197635.26473.a2.

Galiano RD, Hudson D, Shin J, van der Hulst R, Tanaydin V, Djohan R, et al. Incisional Negative Pressure Wound Therapy for Prevention of Wound Healing Complications Following Reduction Mammaplasty. Plast Reconstr Surg Glob Open. 2018;6:e1560. doi: 10.1097/GOX.0000000000001560.

Cogliandro A, Barone M, Cassotta G, Tenna S, Cagli B, Persichetti P. Patient Satisfaction and Clinical Outcomes Following 414 Breast Reductions: Application of BREAST-Q. Aesthetic Plast Surg. 2017;41:245-9. doi: 10.1007/s00266-016-0774-y.

Johnson ON 3rd, Reitz CL, Thai K. Closed Incisional Negative Pressure Therapy Significantly Reduces Early Wound Dehiscence after Reduction Mammaplasty. Plast Reconstr Surg Glob Open. 2021;9:e3496. doi: 10.1097/GOX.0000000000003496.

Sahan C, Gunay T, Simsek H, Soysal A, Ergor G. Socio economic factors associated with tobacco smoking in Turkey: a cross-sectional, population-based study. East Mediterr Health J. 2018;24:705-13. doi: 10.26719/2018.24.8.705..

Rinker B. Theevils of nicotine: an evidence-based guide to smoking and plastic surgery. Ann Plast Surg. 2013;70:599-605. doi: 10.1097/SAP.0b013e3182764fcd.

Sørensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012;255:1069-79. doi: 10.1097/SLA.0b013e31824f632d.

Bikhchandani J, Varma SK, Henderson HP. Is it justified to refuse breast reduction to smokers? J Plast Reconstr Aesthet Surg. 2007;60:1050-4. doi: 10.1016/j.bjps.2007.01.073.

Bartsch RH, Weiss G, Kästenbauer T, Patocka K, Deutinger M, Krapohl BD, et al. Crucialaspects of smoking in wound healing after breast reduction surgery. J Plast Reconstr Aesthet Surg. 2007;60:1045-9. doi: 10.1016/j.bjps.2006.08.001.

Sutinen M, Eskelinen E, Kääriäinen M. Overweight is associated with Increased Incidence of Minor Complications after Reduction Mammoplasty: A Retrospective Analysis of 453 Consecutive Cases. Scand J Surg. 2018;107:230-5. doi: 10.1177/1457496917748225.

Nuzzi LC, Firriolo JM, Pike CM, DiVasta AD, Labow BI. Complications and Quality of Life following Reduction Mammaplasty in Adolescents and Young Women. Plast Reconstr Surg. 2019;144:572-81. doi: 10.1097/PRS.0000000000005907.

Domergue S, Ziade M, Lefevre M, Prud'homme A, Yachouh J. Dermal flaps in breast reduction: prospective study in 100 breasts. J Plast Reconstr Aesthet Surg. 2014;67:e147-50. doi: 10.1016/j.bjps.2014.02.004.

Downloads

Published

2022-01-01

Issue

Section

Research Article

How to Cite

1.
Can B. Factors related to necrosis at the T junction in reduction mammoplasty. J Surg Med [Internet]. 2022 Jan. 1 [cited 2022 Oct. 7];6(1):64-7. Available from: https://jsurgmed.com/article/view/1021186