Dottorato in TECNOLOGIE AVANZATE IN CHIRURGIA

Titolo della tesi: Utilizzo della risonanza magnetica e della mammografia nelle pazienti candidate a mastectomia nipple o skin sparing. Valutazione degli Outcomes chirurgici precoci

Ischemic complications in patients submitted to nipple or skin sparing mastectomy can be severe surgical sequelae that negatively impact the reconstruction causing temporary flap complication up to total loss of the implant. The risk factors for ischemic complications include patient and surgical risk factors. Among these the importance of flap thickness and the role of superficial vascularization in the subcutaneous tissue and in the dermal matrix remain poorly studied. The aim of the study is to evaluate the incidence of skin flap thickness in predicting ischemic complications and how these can be avoided with a correct preoperative study given by the integration of MRI and mammography data. A prospectively maintained institutional database from January 2018 to August 2022 was retrospectively reviewed. All patients with preoperative MRI availability who underwent skin or nipple sparing mastectomy were included in the study. For each patient, an external reviewer blindly calculated the thickness of the flaps from skin to gland on preoperative MRI and breast volume by mammography examination using PACS software. Demographics and outcomes were stratified by those with and without ischemic complications. Of 568 patients submitted to breast surgery, 28 surgical interventions were analyzed of which 20 for unilateral mastectomy and 8 interventions for bilateral mastectomy the latter equal to 16 glands operated with reconstruction, for a total of 36 operated glands. Three cases (8,33%) of ischemic complications were reported: 2 cases (66,67%) of nipple necrosis and 1 case (33,33%) of flap necrosis. All risk factors were analyzed and assessed in relation to ischemic complications. At univariable analysis a correlation with ischemic complications and a history of heart disease (p * 0.008) and with a preoperative thickness on MRI< 8 mm (p * 0.045) were identified. At multivariable analysis the preoperative thickness > 8 mm was an independent predictor inversely correlated with generic ischemic complications (p * 0.037) with strength of association equal to an 18-fold higher frequency of ischemic events (OR 18.1) in patients with flap thickness less than 8 mm. Thickness is a key predictor for assessing the risk of general ischemic complications in patients who are candidates for skin or nipple sparing mastectomy with one- or two-stage reconstructions. The presence of additional factors including heart disease, previous breast surgery or previous chest radiotherapy are certainly worthy of further study and should be the subject of further studies.