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Life sciences · Journal article
Handchirurgie · Mikrochirurgie · Plastische Chirurgie · November 5, 2026
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Abstract Mastectomy skin flap necrosis poses a significant challenge for reconstructive surgeons. Diabetes mellitus, obesity, radiation therapy, and smoking are known risk factors. Mastectomy skin flap necrosis occurs when the metabolic demand of tissues is greater than blood supply. No objective measurements exist to quantify the pre-operative risk of mastectomy skin flap necrosis. We hypothesized that subcutaneous tissue thickness correlates with the risk of mastectomy skin flap necrosis. As pre-operative mammography is routinely performed, it can be used to measure subcutaneous tissue thickness. By determining a relationship between the subcutaneous tissue thickness and the mastectomy skin flap necrosis risk, surgeons may tailor their pre-operative counseling and intra-operative decision making. A retrospective chart review of 50 patients undergoing nipple-sparing mastectomy followed by implant-based or autologous reconstruction was performed. Six patients were excluded as pre-operative mammograms were not available. Thus, the final analysis included 44 patients, comprising 73 operated breasts. Six pre-operative mammographic measurements of subcutaneous tissue thickness were made to determine an average value. Multi-variable logistic regression was used to identify the predictors of mastectomy skin flap necrosis. Twenty-six patients (59.1%) and 38 breasts (52.1%) experienced mastectomy skin flap necrosis. The average subcutaneous tissue thickness was 5.6 mm in those with mastectomy skin flap necrosis compared to 6.4 mm in those without. On multivariable regression, subcutaneous thickness (p=0.04), body mass index (p=0.02), and smoking status (p=0.02) were found to be predictive of mastectomy skin flap necrosis. Subcutaneous tissue thickness was predictive of mastectomy skin flap necrosis. Pre-operative mammography serves as an effective measurement tool to measure the subcutaneous tissue thickness pre-operatively. Further studies may elicit an absolute value for tissue thickness below which mastectomy skin flap necrosis can be reliably predicted.