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

Background: Mastectomy skin flap necrosis (MSFN) is a critical postoperation complication in postmastectomy 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 postsurgical large or larger breast size is a risk factor for MSFN. Objectives: This study asked whether risks of MSFN and other complications were increased when an implant larger than the size of the mastectomy specimen was placed during direct-to-implant (DTI) reconstruction for nipple-sparing mastectomy (NSM). Methods: A 9-year retrospective review of immediate DTI breast reconstruction by 2 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 nonsignificantly lower in the upsize group compared to the downsize group (3.59% vs 4.35%, Conclusions: Increasing breast size was not associated with increased risk of MSFN after NSM with DTI reconstruction. Level of Evidence: 3 (Therapeutic) For image description, please refer to the figure legend and surrounding text.