Nitroglycerin Ointment for Reducing the Rate of Mastectomy Flap Necrosis in Immediate Implant Based Breast Reconstruction

Background: Mastectomy flap necrosis (MFN) remains a challenging complication in immediate tissue expander breast reconstruction (ITEBR). Nitroglycerin ointment has been shown to reduce the incidence of MFN in a randomized controlled study, using 45g per breast and treating one side only in bilateral cases. This study was conducted to determine the efficacy of 15g of nitroglycerin ointment per breast - therefore permitting application to both breasts in cases of bilateral mastectomy. Methods: A retrospective cohort study of patients undergoing ITEBR by a single reconstructive surgeon was conducted. The intervention cohort consisted of all patients between June 10, 2015 and June 9, 2016 (94 patients, 158 breasts), where 15g of nitroglycerin ointment was routinely applied per breast. The control cohort consisted of all patients from June 10, 2014 to June 9, 2015 (107 patients, 170 breasts) where nitroglycerin was not applied. All complications were tracked including minor wound healing problems. Results: There was an overall 22% decreased incidence of MFN in the nitroglycerin ointment cohort (47.5% vs. 60.6%, p=0.002), with a 44% reduction in full thickness MFN that trended towards statistical significance (9.5% vs. 16.5%, p=0.06). On multivariate analysis, nitroglycerin application was independently associated with a decrease in MFN or need for mastectomy flap debridement. There was no significant difference in the incidence of post-operative hypotension (3.8 vs. 2.9%) or headache among cohorts. Conclusion: Topical nitroglycerin ointment application to mastectomy skin flaps at 15g per breast is a cost-effective means to decrease the incidence of MFN in unilateral and bilateral ITEBR. Disclosures: The authors declare that they had no financial interests, commercial associations, or conflicts of interest during the course of this study. Grants: The authors have no external funding sources or grants to declare. Prior presentations: This work has been presented at the 2017 MAPS (Midwest Association of Plastic Surgeons) meeting taking place in Chicago, IL in April 2017 Corresponding Author: Sergey Y Turin, MD, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 N St Clair St., Suite 19-250, Chicago, IL, 60611, 312-695-6022, sergeyturin@gmail.com ©2018American Society of Plastic Surgeons

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