Evolution in Monitoring of Free Flap Autologous Breast Reconstruction After Nipple-Sparing Mastectomy: Is There a Best Way?

Background: Free flap monitoring in autologous reconstruction after nipple-sparing mastectomy (NSM) remains controversial. We therefore examined outcomes in NSM with buried free flap reconstruction versus free flap reconstruction incorporating a monitoring skin paddle. Methods: Autologous free flap reconstructions with NSM performed from 2006 to 2015 were identified. Demographics and operative results were analyzed and compared between buried flaps and those with a skin paddle for monitoring. Results: 221 free flaps for NSM reconstruction were identified: 50 buried flaps and 171 flaps incorporating a skin paddle. Most common flaps used were deep inferior epigastric perforator (DIEP) (64%), profunda artery perforator (PAP) (12.1%), and muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps (10.4%). Autologous reconstructions with a skin paddle had significantly greater BMI (p=0.006). Mastectomy weight (p = 0.017) and flap weight (p