Paul Roblin - Academia.edu (original) (raw)
Papers by Paul Roblin
Journal of Plastic, Reconstructive & Aesthetic Surgery
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020
Burns, Nov 1, 1997
Despite the widespread use of liquid nitrogen, there ate few reports of injuries caused by the us... more Despite the widespread use of liquid nitrogen, there ate few reports of injuries caused by the use of this substance. We vepovt a case in which a severe liquid nitrogen burn, vequiving digital amputation, occurred despite the wearing of protective gloves.
Journal of Plastic, Reconstructive & Aesthetic Surgery
Journal of Plastic, Reconstructive & Aesthetic Surgery
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2021
BACKGROUND Since the earliest use of microscopes in surgery, several modifications have been made... more BACKGROUND Since the earliest use of microscopes in surgery, several modifications have been made to improve the ergonomics of movement and posture, increase the resolution, and expand the visual field. The three-dimensional microscopes are latest innovation in this field. Despite the wider use of 3D microscopes in other specialities, their use in the reconstructive microsurgery in the United Kingdom is still limited. Reconstructive microsurgeons are highly skilled surgeons that are trained to operate utilising the microscope for long hours. This poses an occupational risk with a specific pattern of work-related conditions. AIMS AND METHODS We aim in this report to demonstrate our experience utilising 3D microscopes in small cohort of patients matched to a control of patients operated utilising the traditional microscopes. Patients were matched by age, comorbidities, oncologic procedures. This was complemented by a survey completed by the operating surgeons. RESULTS Nine patients were included in each group. There was no significant difference in operative or ischemia time and no significant post-operative complications in both groups. The surgeons reported better ergonomics, improved staff engagement, and a better teaching experience when utilising the 3D microscopes compared to traditional microscopes. CONCLUSION The utilisation of the 3D microscopes in reconstructive microsurgery has shown to provide comfort, improve ergonomics of movement and posture without significant clinical implications in this series.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020
The importance of a better understanding of the growth response of forest to climate change for m... more The importance of a better understanding of the growth response of forest to climate change for managing and conserving forest has been realized. In this study, we developed the ring-width chronologies of Korean pine (Pinus koraiensis), one of the main constructive species of Changbai Mountain in northeastern China, to examine the radial growth-climate relationships. The stability of these relationships before and after abrupt climate change was evaluated. We built regression equations to project the future growth of the species under future climate change scenarios projected by the Providing Regional Climates for Impacts Studies (PRECISs) climate model. The results were as follows: (1) The chronologies in the three elevation gradients, HY1 at 740 m.s.l., FA at 940 m.s.l. and HY2 at 1258 m.s.l., had the good spatial similarity with high Gleichläfigkeit (GLK) indices; however, significant differences still existed between the growth-climate relationships of the three sites. The width chronology of Korean pine at site HY1 was positively correlated with the precipitation in September of the previous year (p < 0.01) and June of the current year (p < 0.05). The chronology at site FA was positively correlated with the temperature in March and April of the current year (p < 0.05). Whereas the current July temperature and the previous September precipitation were the main limiting factors for the growth of Korean pine at site HY2. (2) Mann-Kendall test results revealed that the climatic data from the meteorological stations near the sampling sites had an abrupt annual average temperature change in 1989, but the radial growth-climate relationship change only occurred in the chronology with May precipitation at site HY2, which may be caused by water stress. (3) With the projected increasing temperature and decreasing precipitation, compared with the base-line period (1971-2000), the radial growth of Korean pine at HY1 will relatively decrease, and the reduction will gradually increase. In contrast, at the higher elevation, like the FA and HY2 sites, the radial growth of Korean pine will relatively increase. Thus, the higher elevation areas of the Korean pine's vertical distribution belt are more favorable for this species' radial growth and forestation.
Burns, 1997
Despite the widespread use of liquid nitrogen, there ate few reports of injuries caused by the us... more Despite the widespread use of liquid nitrogen, there ate few reports of injuries caused by the use of this substance. We vepovt a case in which a severe liquid nitrogen burn, vequiving digital amputation, occurred despite the wearing of protective gloves.
British Journal of Plastic Surgery, 2005
A vertical rectus abdominis myocutaneous flap was used to provide cover for a recurrent angiosarc... more A vertical rectus abdominis myocutaneous flap was used to provide cover for a recurrent angiosarcoma in the abdominal skin. Of note, the patient had 9 years previously undergone formal abdominoplasty to allow closure following excision of the primary tumour. This flap is normally reliant on myocutaneous perforators originating from the deep epigastric system, which are divided during abdominoplasty. Despite this, the flap survived well, implying that a new blood supply had formed during the intervening years. This flap can, therefore, be considered a possible option in reconstructive cases where other options are limited, despite a preceding abdominoplasty. In the future because of the increasingly common occurrence of abdominoplasty in young females, this procedure may need to be considered.
The Annals of The Royal College of Surgeons of England
Soft tissue reconstruction remains a continuing challenge for plastic and reconstructive surgeons... more Soft tissue reconstruction remains a continuing challenge for plastic and reconstructive surgeons. Standard methods of reconstruction such as local tissue transfer and free autologous tissue transfer are successful in addressing soft tissue cover, yet they do not come without the additional morbidity of donor sites. Autologous fat transfer has been used in reconstruction of soft tissue defects in different branches of plastic surgery, specifically breast and facial defect reconstruction, while further maintaining a role in body contouring procedures. Current autologous fat transfer techniques come with the drawbacks of donor-site morbidity and, more significantly, resorption of large amounts of fat. Advancement in tissue engineering has led to the use of engineered adipose tissue structures based on adipose-derived stem cells. This enables a mechanically similar reconstruct that is abundantly available. Cosmetic and mechanical similarity with native tissue is the main clinical goal for engineered adipose tissue. Development of novel techniques in the availability of natural tissue is an exciting prospect; however, it is important to investigate the potential of cell sources and culture strategies for clinical applications. We review these techniques and their applications in plastic surgery.
Pelvi-perineal flap reconstruction: normal imaging appearances and post-operative complications o... more Pelvi-perineal flap reconstruction: normal imaging appearances and post-operative complications on cross-sectional imaging
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020
The practice of partial mastectomy (PM) in patients with breast cancer has gained momentum over t... more The practice of partial mastectomy (PM) in patients with breast cancer has gained momentum over total mastectomy since the results of randomized clinical trials that have provided evidence demonstrating equivalent survival. 1 But in recent years there has been a relative decline in PM compared to bilateral mastectomies, which has been attributed to inadequate esthetic outcomes after PM without reconstruction, which ultimately affects patient satisfaction and their health-related quality of life. 2 On the other hand, PM with immediate reconstruction-what we define as oncoplastic breast surgery (OPBS)-has been proven to be a safe and efficacious means of improving both aesthetics outcomes compared to PM alone without affecting oncological outcomes. 3 Despite the benefits of OPBS, its nationwide utilization has never been precisely quantified. To facilitate future efforts to increase its availability to appropriate candidate patients, this study aims to establish the recent rate and temporal trends of national utilization of OPBS. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was reviewed for the period 2006-2015 to identify all women 18 years and older who were diagnosed with invasive breast cancer or carcinoma in situ, and underwent PM, as well as identify the subset of women who also underwent any reconstructive procedure during the 30-day postoperative period. The primary outcome was the overall rate of OPBS for the study period, and the temporal trends from 2006 to 2015. The secondary outcome was the annual trend for each OPBS technique: volume displacement (VD), breast reduction (BR), volume reduction (VR), prosthesis, and mastopexy. All statistical tests were two-sided, and p-value of < 0.05 was considered significant. A total 91,129 women underwent PM during the period 2006-2015 of which 4.2% (n = 3777
British Journal of Surgery, 2014
BMJ Case Reports, 2021
Vascularised epiphysial fibula bone transfers in the paediatric population provides a solution to... more Vascularised epiphysial fibula bone transfers in the paediatric population provides a solution to growth suppression in extremity reconstruction. We report a case of an anatomical variant to the epiphysial blood supply that has never been reported in literature. A 6-year-old girl underwent a free vascularised fibula flap for reconstruction of her right humerous following osteosarcoma resection. While identifying and dissecting the recurrent epiphysial branch, a large branch from the peroneal artery was identified which directly entered the head of the fibula. No dominant supply from the anterior tibial (AT) vessels to the head of the fibula was seen. This led to the need for a bipedicled flap with diaphyseal supply from the AT vessels and the epiphysial transfer based on the peroneal artery. The patient made an uneventful recovery from the procedure. The same technique may be used by surgeons that may encounter this unique variant in clinical practice.
Cureus, 2021
Background and objective The coronavirus disease 2019 (COVID-19) pandemic has led to many challen... more Background and objective The coronavirus disease 2019 (COVID-19) pandemic has led to many challenges in face-to-face teaching and training in plastic surgery. However, it has also proved to be an incubator for many technological solutions. Augmented reality (AR) platforms may offer a safe, equitable, and efficient means to provide training in plastic surgery. This study aimed to explore the user's experience of AR as an educational intervention during the COVID-19 pandemic in the United Kingdom (UK). Materials and methods The Proximie® AR platform (Proximie Limited, London, UK) has been in use in a UK plastic surgical department for facilitating webinars, visual libraries, and streamed procedures. The experience of a range of trainers and trainees was qualitatively explored through 10 individual interviews. Data-emergent theme analysis was also performed. Results AR was well-received in the context of COVID-19 and training in general as a means to enable theatre access, and visual revision, remotely. The potential for its use in remote coaching and telementoring was also discussed. Recommendations were made by the users to optimise the experience both from the trainer and learner perspectives. Data were presented pertaining to the following themes: surgical AR as a substitute for hands-on learning; surgical AR and theoretical learning; considerations specific to streamed procedures using Proximie®; considerations in the use of technology in general. Conclusion Harnessing novel technologies in surgical education offers an exciting opportunity, fast-tracked by COVID-19, but applicable beyond it. Though this study includes a small sample size, its findings suggest that AR platforms may offer a uniquely interactive remote educational experience in surgical training. Strategies and suggestions for its use are discussed, as well as broader considerations in using technology in surgical education.
Hand Clinics, 2000
Benign and malignant tumors of the hand are rare in children. This article reviews some of the co... more Benign and malignant tumors of the hand are rare in children. This article reviews some of the common tumors that affect the hand in children, with an emphasis on clinico-pathologic correlations. Illustrated case histories on some rare tumors are also included.
Gut, 2015
screened from the search for eligibility. Fifty-seven articles were found be studies relevant for... more screened from the search for eligibility. Fifty-seven articles were found be studies relevant for gene expression profiles of CRC. Eight articles met inclusion criteria hence included for quantitative synthesis. All the biomarkers identified in this review were divided according to six-predefined hallmarks of cancer progression. We considered the hallmarks of angiogenesis, invasion and metastasis to represent late events and we identified a total of more than 30 associated protein biomarkers. We used the graph web network software to analyse proteinprotein interaction among the protein biomarkers representing late hallmarks. Results 13 Hub protein molecules, which scored more than 90% function in the networks, are mostly ribosomal proteins they are:
The Breast, 2011
Skin sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is not only oncol... more Skin sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is not only oncologically safe but provides also significant benefits both cosmetically and functionally. The superiority of this technique can only be fully established, however, by developing a framework for minimising complications. The present study seeks to elucidate the key factors affecting outcome. Methods: Data for all skin sparing mastectomies with immediate autologous and implant based reconstructions, performed in a three year period (2006e2008) was retrospectively collated. Complications were classified into major and minor. Patients were excluded who had flap loss due to vascular complications. Results: The total number analysed was 151. 17.2% had major complications, 23% had minor and 61% had no complications. The Wise and the "tennis" incision had significantly higher rates of wound dehiscence when compared with the periareolar incision (p ¼ 0.025, p ¼ 0.098). There was no significant difference between diathermy or blade dissection techniques, or the use of subcutaneous adrenaline infiltration. Increasing BMI was associated with increased skin flap necrosis and wound dehiscence, and an excised breast mass of greater than 750 g and a sternal notch to nipple length of greater than 26 cm are associated as well with increased flap-related complications (p ¼ 0.0002, p ¼ 0.0049). Conclusion: Factors such as Wise pattern and tennis racquet incision, BMI and breast mass and sternal notch to nipple length adversely affect skin sparing mastectomy flap morbidity. These factors should be factored in to patient selection and operative planning especially for obese and large breasted women undergoing skin sparing mastectomy with immediate breast reconstruction.
Journal of Plastic, Reconstructive & Aesthetic Surgery
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020
Burns, Nov 1, 1997
Despite the widespread use of liquid nitrogen, there ate few reports of injuries caused by the us... more Despite the widespread use of liquid nitrogen, there ate few reports of injuries caused by the use of this substance. We vepovt a case in which a severe liquid nitrogen burn, vequiving digital amputation, occurred despite the wearing of protective gloves.
Journal of Plastic, Reconstructive & Aesthetic Surgery
Journal of Plastic, Reconstructive & Aesthetic Surgery
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2021
BACKGROUND Since the earliest use of microscopes in surgery, several modifications have been made... more BACKGROUND Since the earliest use of microscopes in surgery, several modifications have been made to improve the ergonomics of movement and posture, increase the resolution, and expand the visual field. The three-dimensional microscopes are latest innovation in this field. Despite the wider use of 3D microscopes in other specialities, their use in the reconstructive microsurgery in the United Kingdom is still limited. Reconstructive microsurgeons are highly skilled surgeons that are trained to operate utilising the microscope for long hours. This poses an occupational risk with a specific pattern of work-related conditions. AIMS AND METHODS We aim in this report to demonstrate our experience utilising 3D microscopes in small cohort of patients matched to a control of patients operated utilising the traditional microscopes. Patients were matched by age, comorbidities, oncologic procedures. This was complemented by a survey completed by the operating surgeons. RESULTS Nine patients were included in each group. There was no significant difference in operative or ischemia time and no significant post-operative complications in both groups. The surgeons reported better ergonomics, improved staff engagement, and a better teaching experience when utilising the 3D microscopes compared to traditional microscopes. CONCLUSION The utilisation of the 3D microscopes in reconstructive microsurgery has shown to provide comfort, improve ergonomics of movement and posture without significant clinical implications in this series.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020
The importance of a better understanding of the growth response of forest to climate change for m... more The importance of a better understanding of the growth response of forest to climate change for managing and conserving forest has been realized. In this study, we developed the ring-width chronologies of Korean pine (Pinus koraiensis), one of the main constructive species of Changbai Mountain in northeastern China, to examine the radial growth-climate relationships. The stability of these relationships before and after abrupt climate change was evaluated. We built regression equations to project the future growth of the species under future climate change scenarios projected by the Providing Regional Climates for Impacts Studies (PRECISs) climate model. The results were as follows: (1) The chronologies in the three elevation gradients, HY1 at 740 m.s.l., FA at 940 m.s.l. and HY2 at 1258 m.s.l., had the good spatial similarity with high Gleichläfigkeit (GLK) indices; however, significant differences still existed between the growth-climate relationships of the three sites. The width chronology of Korean pine at site HY1 was positively correlated with the precipitation in September of the previous year (p < 0.01) and June of the current year (p < 0.05). The chronology at site FA was positively correlated with the temperature in March and April of the current year (p < 0.05). Whereas the current July temperature and the previous September precipitation were the main limiting factors for the growth of Korean pine at site HY2. (2) Mann-Kendall test results revealed that the climatic data from the meteorological stations near the sampling sites had an abrupt annual average temperature change in 1989, but the radial growth-climate relationship change only occurred in the chronology with May precipitation at site HY2, which may be caused by water stress. (3) With the projected increasing temperature and decreasing precipitation, compared with the base-line period (1971-2000), the radial growth of Korean pine at HY1 will relatively decrease, and the reduction will gradually increase. In contrast, at the higher elevation, like the FA and HY2 sites, the radial growth of Korean pine will relatively increase. Thus, the higher elevation areas of the Korean pine's vertical distribution belt are more favorable for this species' radial growth and forestation.
Burns, 1997
Despite the widespread use of liquid nitrogen, there ate few reports of injuries caused by the us... more Despite the widespread use of liquid nitrogen, there ate few reports of injuries caused by the use of this substance. We vepovt a case in which a severe liquid nitrogen burn, vequiving digital amputation, occurred despite the wearing of protective gloves.
British Journal of Plastic Surgery, 2005
A vertical rectus abdominis myocutaneous flap was used to provide cover for a recurrent angiosarc... more A vertical rectus abdominis myocutaneous flap was used to provide cover for a recurrent angiosarcoma in the abdominal skin. Of note, the patient had 9 years previously undergone formal abdominoplasty to allow closure following excision of the primary tumour. This flap is normally reliant on myocutaneous perforators originating from the deep epigastric system, which are divided during abdominoplasty. Despite this, the flap survived well, implying that a new blood supply had formed during the intervening years. This flap can, therefore, be considered a possible option in reconstructive cases where other options are limited, despite a preceding abdominoplasty. In the future because of the increasingly common occurrence of abdominoplasty in young females, this procedure may need to be considered.
The Annals of The Royal College of Surgeons of England
Soft tissue reconstruction remains a continuing challenge for plastic and reconstructive surgeons... more Soft tissue reconstruction remains a continuing challenge for plastic and reconstructive surgeons. Standard methods of reconstruction such as local tissue transfer and free autologous tissue transfer are successful in addressing soft tissue cover, yet they do not come without the additional morbidity of donor sites. Autologous fat transfer has been used in reconstruction of soft tissue defects in different branches of plastic surgery, specifically breast and facial defect reconstruction, while further maintaining a role in body contouring procedures. Current autologous fat transfer techniques come with the drawbacks of donor-site morbidity and, more significantly, resorption of large amounts of fat. Advancement in tissue engineering has led to the use of engineered adipose tissue structures based on adipose-derived stem cells. This enables a mechanically similar reconstruct that is abundantly available. Cosmetic and mechanical similarity with native tissue is the main clinical goal for engineered adipose tissue. Development of novel techniques in the availability of natural tissue is an exciting prospect; however, it is important to investigate the potential of cell sources and culture strategies for clinical applications. We review these techniques and their applications in plastic surgery.
Pelvi-perineal flap reconstruction: normal imaging appearances and post-operative complications o... more Pelvi-perineal flap reconstruction: normal imaging appearances and post-operative complications on cross-sectional imaging
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020
The practice of partial mastectomy (PM) in patients with breast cancer has gained momentum over t... more The practice of partial mastectomy (PM) in patients with breast cancer has gained momentum over total mastectomy since the results of randomized clinical trials that have provided evidence demonstrating equivalent survival. 1 But in recent years there has been a relative decline in PM compared to bilateral mastectomies, which has been attributed to inadequate esthetic outcomes after PM without reconstruction, which ultimately affects patient satisfaction and their health-related quality of life. 2 On the other hand, PM with immediate reconstruction-what we define as oncoplastic breast surgery (OPBS)-has been proven to be a safe and efficacious means of improving both aesthetics outcomes compared to PM alone without affecting oncological outcomes. 3 Despite the benefits of OPBS, its nationwide utilization has never been precisely quantified. To facilitate future efforts to increase its availability to appropriate candidate patients, this study aims to establish the recent rate and temporal trends of national utilization of OPBS. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was reviewed for the period 2006-2015 to identify all women 18 years and older who were diagnosed with invasive breast cancer or carcinoma in situ, and underwent PM, as well as identify the subset of women who also underwent any reconstructive procedure during the 30-day postoperative period. The primary outcome was the overall rate of OPBS for the study period, and the temporal trends from 2006 to 2015. The secondary outcome was the annual trend for each OPBS technique: volume displacement (VD), breast reduction (BR), volume reduction (VR), prosthesis, and mastopexy. All statistical tests were two-sided, and p-value of < 0.05 was considered significant. A total 91,129 women underwent PM during the period 2006-2015 of which 4.2% (n = 3777
British Journal of Surgery, 2014
BMJ Case Reports, 2021
Vascularised epiphysial fibula bone transfers in the paediatric population provides a solution to... more Vascularised epiphysial fibula bone transfers in the paediatric population provides a solution to growth suppression in extremity reconstruction. We report a case of an anatomical variant to the epiphysial blood supply that has never been reported in literature. A 6-year-old girl underwent a free vascularised fibula flap for reconstruction of her right humerous following osteosarcoma resection. While identifying and dissecting the recurrent epiphysial branch, a large branch from the peroneal artery was identified which directly entered the head of the fibula. No dominant supply from the anterior tibial (AT) vessels to the head of the fibula was seen. This led to the need for a bipedicled flap with diaphyseal supply from the AT vessels and the epiphysial transfer based on the peroneal artery. The patient made an uneventful recovery from the procedure. The same technique may be used by surgeons that may encounter this unique variant in clinical practice.
Cureus, 2021
Background and objective The coronavirus disease 2019 (COVID-19) pandemic has led to many challen... more Background and objective The coronavirus disease 2019 (COVID-19) pandemic has led to many challenges in face-to-face teaching and training in plastic surgery. However, it has also proved to be an incubator for many technological solutions. Augmented reality (AR) platforms may offer a safe, equitable, and efficient means to provide training in plastic surgery. This study aimed to explore the user's experience of AR as an educational intervention during the COVID-19 pandemic in the United Kingdom (UK). Materials and methods The Proximie® AR platform (Proximie Limited, London, UK) has been in use in a UK plastic surgical department for facilitating webinars, visual libraries, and streamed procedures. The experience of a range of trainers and trainees was qualitatively explored through 10 individual interviews. Data-emergent theme analysis was also performed. Results AR was well-received in the context of COVID-19 and training in general as a means to enable theatre access, and visual revision, remotely. The potential for its use in remote coaching and telementoring was also discussed. Recommendations were made by the users to optimise the experience both from the trainer and learner perspectives. Data were presented pertaining to the following themes: surgical AR as a substitute for hands-on learning; surgical AR and theoretical learning; considerations specific to streamed procedures using Proximie®; considerations in the use of technology in general. Conclusion Harnessing novel technologies in surgical education offers an exciting opportunity, fast-tracked by COVID-19, but applicable beyond it. Though this study includes a small sample size, its findings suggest that AR platforms may offer a uniquely interactive remote educational experience in surgical training. Strategies and suggestions for its use are discussed, as well as broader considerations in using technology in surgical education.
Hand Clinics, 2000
Benign and malignant tumors of the hand are rare in children. This article reviews some of the co... more Benign and malignant tumors of the hand are rare in children. This article reviews some of the common tumors that affect the hand in children, with an emphasis on clinico-pathologic correlations. Illustrated case histories on some rare tumors are also included.
Gut, 2015
screened from the search for eligibility. Fifty-seven articles were found be studies relevant for... more screened from the search for eligibility. Fifty-seven articles were found be studies relevant for gene expression profiles of CRC. Eight articles met inclusion criteria hence included for quantitative synthesis. All the biomarkers identified in this review were divided according to six-predefined hallmarks of cancer progression. We considered the hallmarks of angiogenesis, invasion and metastasis to represent late events and we identified a total of more than 30 associated protein biomarkers. We used the graph web network software to analyse proteinprotein interaction among the protein biomarkers representing late hallmarks. Results 13 Hub protein molecules, which scored more than 90% function in the networks, are mostly ribosomal proteins they are:
The Breast, 2011
Skin sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is not only oncol... more Skin sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is not only oncologically safe but provides also significant benefits both cosmetically and functionally. The superiority of this technique can only be fully established, however, by developing a framework for minimising complications. The present study seeks to elucidate the key factors affecting outcome. Methods: Data for all skin sparing mastectomies with immediate autologous and implant based reconstructions, performed in a three year period (2006e2008) was retrospectively collated. Complications were classified into major and minor. Patients were excluded who had flap loss due to vascular complications. Results: The total number analysed was 151. 17.2% had major complications, 23% had minor and 61% had no complications. The Wise and the "tennis" incision had significantly higher rates of wound dehiscence when compared with the periareolar incision (p ¼ 0.025, p ¼ 0.098). There was no significant difference between diathermy or blade dissection techniques, or the use of subcutaneous adrenaline infiltration. Increasing BMI was associated with increased skin flap necrosis and wound dehiscence, and an excised breast mass of greater than 750 g and a sternal notch to nipple length of greater than 26 cm are associated as well with increased flap-related complications (p ¼ 0.0002, p ¼ 0.0049). Conclusion: Factors such as Wise pattern and tennis racquet incision, BMI and breast mass and sternal notch to nipple length adversely affect skin sparing mastectomy flap morbidity. These factors should be factored in to patient selection and operative planning especially for obese and large breasted women undergoing skin sparing mastectomy with immediate breast reconstruction.