Arch Plast Surg.  2014 May;41(3):258-263. 10.5999/aps.2014.41.3.258.

Methylene Blue Dye-Induced Skin Necrosis in Immediate Breast Reconstruction: Evaluation and Management

• Lee JH
• Chang CH
• Park CH
• Kim JK

• KMID: 2120872
• DOI: http://doi.org/10.5999/aps.2014.41.3.258

Abstract

BACKGROUND
For early breast cancer patients, skin-sparing mastectomy or nipple-sparing mastectomy with sentinel lymph node biopsy has become the mainstream treatment for immediate breast reconstruction in possible cases. However, a few cases of skin necrosis caused by methylene blue dye (MBD) used for sentinel lymph node localization have been reported.
METHODS
Immediate breast reconstruction using a silicone implant was performed on 35 breasts of 34 patients after mastectomy. For sentinel lymph node localization, 1% MBD (3 mL) was injected into the subareolar area. The operation site was inspected in the postoperative evaluation.
RESULTS
Six cases of immediate breast reconstruction using implants were complicated by methylene blue dye. One case of local infection was improved by conservative treatment. In two cases, partial necrosis and wound dehiscence of the incision areas were observed; thus, debridement and closure were performed. Of the three cases of wide skin necrosis, two cases underwent removal of the dead tissue and implants, followed by primary closure. In the other case, the breast implant was salvaged using latissimus dorsi musculocutaneous flap reconstruction.
CONCLUSIONS
The complications were caused by MBD toxicity, which aggravated blood disturbance and skin tension after implant insertion. When planning immediate breast reconstruction using silicone implants, complications of MBD should be discussed in detail prior to surgery, and appropriate management in the event of complications is required.

Keyword

Breast implantation; Necrosis; Methylene blue; Sentinel lymph node biopsy; Breast neoplasm

MeSH Terms

Breast
Breast Implantation
Breast Implants
Breast Neoplasms
Debridement
Female
Humans
Lymph Nodes
Mammaplasty*
Mastectomy
Methylene Blue*
Myocutaneous Flap
Necrosis*
Sentinel Lymph Node Biopsy
Silicones
Skin*
Superficial Back Muscles
Wounds and Injuries
Methylene Blue
Silicones