Does Breast Implant Size Larger than Mastectomy Specimen Size Increase the Risk of Flap Necrosis?

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ID: 313457
2026
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Abstract
Abstract Background Mastectomy skin flap necrosis (MSFN) is a critical post operation complication in post-mastectomy breast reconstruction. High replacement tissue expander fill volume and large mastectomy specimen size are commonly assumed to increase MSFN risk. Thus, a common recommendation in the practicing surgeon’s office is not to increase breast volume during reconstruction. However, there is minimal literature on the question of whether post-surgical large or larger breast size is a risk factor for MSFN. Objectives This study asks whether risks of MSFN and other complications are increased when an implant larger than the size of the mastectomy specimen is placed during direct-to-implant (DTI) reconstruction for nipple sparing mastectomy (NSM). Methods A 9-year retrospective review of immediate DTI breast reconstruction by two surgeons at a private clinic was conducted encompassing a total of 499 breasts in 270 consecutive adult female patients. Compared were patients with breasts that had implants placed greater in size in cubic centimeters than the weight of mastectomy specimen in grams (the upsize group, n = 361) vs. those that had smaller implants placed (the downsize group, n = 138). Results MSFN was non-significantly lower in the upsize group compared to the downsize group (3.59% vs. 4.35%, p = 0.6966). When secondary outcomes differed significantly, complications were higher in the downsize group. BMI, but not size difference between specimen and implant, significantly predicted MSFN in logistic regression modeling. Conclusions Increasing breast size was not associated with increased risk of MSFN after NSM with DTI reconstruction.
Reference Key
openalex_W7161263022 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Lisa B. Cassileth, Kelly Killeen, Amy York, D.T. Rosen
Journal Aesthetic Surgery Journal Open Forum
Year 2026
DOI
10.1093/asjof/ojag063
URL
https://doi.org/10.1093/asjof/ojag063
Keywords Keywords not found

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