Topical nitroglycerin ointment reduces mastectomy flap necrosis in immediate autologous breast reconstruction

• Published in: Plastic and reconstructive surgery (1963) Vol. 152; no. 4; pp. 728 - 735
• Main Authors: Yao, Amy, Greige, Nicolas, Ricci, Joseph A., Draper, Lawrence B., Weichman, Katie E.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-10-2023
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/PRS.0000000000010349

Mastectomy flap necrosis is a common complication of immediate breast reconstruction that greatly impacts patient satisfaction and cosmetic outcomes. Topical nitroglycerin ointment, at low cost and with negligible side effects, has been shown to significantly decrease the incidence of mastectomy flap necrosis in immediate implant-based breast reconstruction. However, the utility of nitroglycerin ointment has not been studied in immediate autologous reconstruction.
After obtaining IRB approval, a prospective cohort study of all consecutive patients undergoing immediate free flap breast reconstruction by a single reconstructive surgeon at a single institution between February 2017 and September 2021 was performed. Patients were divided into two cohorts: those receiving 30mg of topical nitroglycerin ointment to each breast at the conclusion of the operation (September 2019-September 2021) and those who did not (February 2017-August 2019). All patients underwent intraoperative SPY angiography, and mastectomy skin flaps were debrided intraoperatively based on imaging. Independent demographic variables were analyzed and dependent outcome variables included mastectomy skin flap necrosis, headache, and hypotension requiring removal of ointment.
A total of thirty-five patients (49 breasts) were included in the nitroglycerin cohort and a total of thirty-four patients (49 breasts) were included in the control group. There was no significant difference in patient demographics, medical comorbidities, or mastectomy weight between cohorts. The rate of mastectomy flap necrosis decreased from 51% in the control group to 26.5% in the group that received nitroglycerin ointment (p=0.013). There were no documented adverse events associated with nitroglycerin use.
Topical nitroglycerin ointment significantly decreases the rate of mastectomy flap necrosis in patients undergoing immediate autologous breast reconstruction without significant adverse effects.