How Does MSFN Risk Shape Multidisciplinary Treatment Planning?

Lisa Cassileth, MD, FACS, chief executive officer and founder of The Practice Healthcare, discussed the broader clinical implications of mastectomy skin flap necrosis (MSFN), a complication that can delay adjuvant systemic therapy or radiation after breast reconstruction. Cassileth highlighted MSFN as an underrecognized problem for both patients and physicians, urging for more transparency around individual surgeons’ complication rates so that multidisciplinary teams can better coordinate treatment timing and reduce delays in cancer care.

Transcript:

CancerNetwork: MSFN can significantly delay systemic therapy or radiation. How do these findings impact multidisciplinary treatment planning when coordinating timing with medical and radiation oncologists?

Cassileth: MSFN is a huge, underrecognized complication within the patient community, and the physician community is also a bit unsure of what to do about it. [Rates are] high, so I’d urge more action on the part of plastic surgeons and patients to do their research on which surgeons have the lowest rate of mastectomy flap necrosis, as it can delay treatment. If you look across different centers, and even individual doctors within a center, what you’ll typically see, even at wonderful institutions like Memorial Sloan Kettering, MD Anderson, and the University of California Los Angeles [UCLA], is that the lowest rate of major complications, including mastectomy flap necrosis, implant loss, and serious infection, is around 22% if you look at data published over the last 10 years. This is just one tiny piece of the puzzle in figuring out what causes these [complications]. We know it’s not about a bigger implant as long as it’s closed under no tension.

In a weird way, the larger implant that’s more appropriate for that patient could, in many cases, be the better choice, not the worse one. We also have to work out every other aspect of what we can do to lower this risk. We’ve brought our own rate down to 1.5%. Do we need hyperbaric [oxygen]? Is it more than just the implant? We’re starting to look at all the other [factors] to figure out how we get that rate down because patients don’t want a complication or an implant loss on top of chemotherapy and radiation, and honestly, even patients who aren’t having chemotherapy and radiation don’t want a complication either. We don’t want anyone to be deformed. We want the surgery to be a single moment in the patient’s life, and then once they’re reconstructed, they move on. I don’t want to say forget it ever happened, but ideally, they have something long-lasting that’s never had a problem since the day of surgery.