The recent June 2015 issue of Plastic & Reconstructive Surgery Journal has an article, “Effects of Nitroglycerin Ointment on Mastectomy Flap Necrosis in Immediate Reconstruction: A Randomized Controlled Trial.” It is a study out of Canada. Love randomized controlled studies. It is the best scientific data we can have.
Maybe it is my age, the number of my friends who are having breast cancer, or the commonality of breast cancer, but I feel like I am talking about breast cancer a lot these days. Many of my friends are getting premenopausal breast cancer, and the question is: mastectomy or lumpectomy? and one side or both?
Mastectomies can have flap necrosis, which in English means part of your skin dies. When this skin is the nipple and areola, there is a big cosmetic effect, not to mention the risk of exposure of the underlying implant. These investigators were looking at nitroglycerin, which is a vasodilator (dilates the blood vessels, thereby increasing arterial blood flow and venous flow). There are prior studies which indicate nitroglycerin would help (one looked at 1ml, 5mg dose) and the other looked at a patch (50mg/8 hours/day for 5 days)
Study: This study looked at 165 patients. They were randomized to nitroglycerin ointment 45mg (Nitrobid 2% ointment) or placebo. It was applied to the mastectomy skin at the time of surgery. Patients who could not have nitroglycerin were excluded from the study (low blood pressure, heart issues, liver impairment, certain medications).
Findings:
- Placebo had 34% incidence of flap necrosis, those with nitroglycerin had 15%.
- Post op complications were similar in both groups.
Conclusion?
They feel in patients undergoing mastectomy with immediate reconstruction there was a marked reduction in mastectomy flap necrosis in patients who had a simple placement of nitroglycerin ointment at the time of surgery.
Interesting.