Necrosis, defined as tissue death, can occur as a complication following mastectomy surgery. Its prevention is important for successful healing and patient well-being after the procedure.
Pre-Surgical Strategies
Optimizing a patient’s health before mastectomy reduces the risk of tissue complications. Managing existing health conditions, such as diabetes or cardiovascular issues, helps ensure adequate blood flow and promotes healing. Uncontrolled medical conditions can impair circulation.
Quitting smoking well in advance of surgery is important. Smoking constricts blood vessels, reducing oxygen and nutrient delivery to tissues and hindering wound healing. Patients are advised to cease smoking weeks before surgery for improved circulation.
Proper nutrition and hydration contribute to the body’s ability to heal. A diet rich in essential nutrients supports cellular repair and immune function, while adequate hydration helps maintain blood volume and tissue perfusion. Patients should discuss diet with their team.
A thorough review of all medications with the surgical team is necessary. Certain medications, such as blood thinners, can affect clotting and healing. Adjustments or temporary cessation of some medications might be recommended.
The surgeon’s assessment of individual patient factors, including body mass index and skin quality, informs the surgical plan. This personalized evaluation helps identify risks and allows the surgical team to implement tailored strategies to reduce the likelihood of necrosis.
Intra-Operative Measures
During mastectomy, surgeons employ specific techniques to safeguard tissue viability and prevent necrosis. Careful planning of the skin flaps is paramount to ensure they retain sufficient blood supply. This involves designing incisions and performing dissections that minimize tension on the skin and preserve blood vessels within the flap.
Meticulous control of bleeding (hemostasis) is important. Preventing hematomas is important because these can compress blood vessels and compromise blood flow. Surgeons use various methods for hemostasis.
Gentle handling of tissues by the surgical team minimizes trauma to vascular structures. Excessive manipulation or rough dissection can damage small blood vessels, leading to impaired circulation in the skin flaps. An atraumatic technique preserves the integrity of the subdermal plexus, a network of blood vessels just beneath the skin.
Maintaining the patient’s core body temperature optimizes circulation during surgery. A stable body temperature supports normal physiological processes, including blood flow to peripheral tissues.
Surgeons may utilize advanced technologies, such as indocyanine green angiography (ICGA), to assess blood flow in real-time. This technique helps identify areas of compromised perfusion, allowing the surgeon to make adjustments to improve blood supply and reduce the risk of necrosis.
Post-Operative Care
Following mastectomy, diligent post-operative care supports healing and prevents complications like necrosis. Proper wound care involves keeping the surgical site clean and dry, and adhering to dressing change instructions. This helps prevent infection, which can hinder healing.
If surgical drains are placed, their correct management is important. These drains help remove excess fluid that can accumulate, preventing fluid buildup that might compromise blood supply to healing tissues.
Avoiding pressure and constriction on the surgical site is important. Patients should avoid tight clothing or anything that could exert undue pressure on healing tissues, as this can restrict blood flow.
Monitoring for early signs of potential necrosis is important. Patients and caregivers should regularly check the surgical site for changes in skin color, such as darkening or a purplish hue, coolness, blistering, or unusual pain. These signs indicate a possible compromise in blood flow.
Adhering to activity restrictions helps prevent strain on healing tissues. Overexertion or sudden movements can disrupt the healing process and impact the surgical site. Gradually increasing activity levels as advised is recommended.
Attending all scheduled follow-up appointments allows the medical team to assess healing progress and identify concerns early. During these visits, the surgeon can examine the wound, check for complications, and provide further guidance.