NESPS - Hyperbaric Oxygen Therapy for Oncoplastic Mastectomy Flap Ischemia: An Academic Multi-Center Analysis

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Hyperbaric Oxygen Therapy for Oncoplastic Mastectomy Flap Ischemia: An Academic Multi-Center Analysis
Rebecca Friedman^*, Soniya singh, Hani Nasr, William Rifkin, John N. Muller, Scott Gorenstein, Ernest Chiu
Hansjorg Wyss Department of Plastic Surgery, NYU Langone Health, New York City , NY

Background: Post-mastectomy breast reconstruction is standard of care in breast cancer treatment. Postoperative complications such as mastectomy skin flap ischemia/necrosis are a source of significant morbidity and reduced quality of life, potentially delaying further oncologic care. Hyperbaric oxygen therapy (HBOT) has been shown to improve outcomes in treating compromised flaps or grafts. We sought to assess our institution's clinical outcomes for HBOT salvage of mastectomy flaps.
Methods: Retrospective analysis of patients treated with HBOT after mastectomy at our institution was performed. HBOT involved 90-minute HBOT sessions at 2.0 or 2.5 ATA. Patient demographics, surgical characteristics, treatment indications, flap salvage, and HBOT outcomes were recorded.
Results: 100 patients and 174 breasts were evaluated. Mean age was 46.79±10.30 and mean time to HBOT initiation was 10.1±8.9 days. Initial reconstruction included tissue-expander placement (59%), autologous reconstruction with DIEP flaps (18%), and direct-to-implant reconstruction (23%). HBOT indications included ischemia for 66 breasts (37.9%), venous congestion for 40 breasts (23%), wound dehiscence for 15 breasts (8.6%), and partial thickness necrosis for 53 breasts (30.5%).
Flap salvage was achieved in 157 breasts (90.2%). 12 breasts (6.7%) required revisions within 6 weeks post-operatively, including debridement with skin grafting(n=9), and scar revision (n=6, 3.45%). 39 (22.4%) breasts underwent revisions after 6 weeks, including tissue expander removal and implant placement (n=26, 14.9%), with fat injection in an additional 8 (4.6%) of those patients, implant replacement in 6 (3.45%) and debridement with skin grafting in 8 (4.6%) patients. Minor HBOT-related adverse events were observed in 15 patients
Conclusions: Oncoplastic mastectomy and reconstruction are important tools for breast cancer treatment, but ischemic complications remain a risk. HBOT is a possible adjunct intervention, and we demonstrate its ability to help salvage threatened mastectomy flaps with excellent outcomes in a large cohort.