Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2014; 41(03): 258-263
DOI: 10.5999/aps.2014.41.3.258
Original Article

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

Ji Hwan Lee
Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
,
Choong Hyun Chang
Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
,
Chan Heun Park
Department of Breast and Thyroid Cancer, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
,
June-Kyu Kim
Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
› Author Affiliations
› Further Information
   Permissions and Reprints

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.

Keywords

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


Publication History

Received: 22 July 2013

Accepted: 09 September 2013

Article published online:
02 May 2022

© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 American Society of Breast Surgeons. Consensus statement on guidelines for performing sentinel lymph node dissection in breast cancer [Internet]. Columbia: American Society of Breast Surgeons; c2010 [cited 2005 Dec 8]. Available from: https://www.breastsurgeons.org/statements/PDF_Statements/SLN_Dissection.pdf
  • 2 Nagao T, Kinoshita T, Hojo T. et al. Sentinel lymph node biopsy using indigo carmine blue dye and the validity of '10% rule' and '4 nodes rule'. Breast 2012; 21: 455-458
    CrossrefPubMedGoogle Scholar
  • 3 Simmons RM, Smith SM, Osborne MP. Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization. Breast J 2001; 7: 181-183
    CrossrefPubMedGoogle Scholar
  • 4 Kinoshita S, Nojima K, Takeishi M. et al. Retrospective comparison of non-skin-sparing mastectomy and skin-sparing mastectomy with immediate breast reconstruction. Int J Surg Oncol 2011; 2011: 876520
    PubMedGoogle Scholar
  • 5 Niemeyer M, Paepke S, Schmid R. et al. Extended indications for nipple-sparing mastectomy. Breast J 2011; 17: 296-299
    CrossrefPubMedGoogle Scholar
  • 6 Cho YK, Yang JD, Kim GR. et al. Immediate implant reconstruction using silicone prosthesis in breast cancer patients after skin sparing mastectomy. J Korean Soc Plast Reconstr Surg 2010; 37: 749-757
    Google Scholar
  • 7 Reyes F, Noelck M, Valentino C. et al. Complications of methylene blue dye in breast surgery: case reports and review of the literature. J Cancer 2010; 2: 20-25
    Google Scholar
  • 8 Stradling B, Aranha G, Gabram S. Adverse skin lesions after methylene blue injections for sentinel lymph node localization. Am J Surg 2002; 184: 350-352
    CrossrefPubMedGoogle Scholar
  • 9 Zakaria S, Hoskin TL, Degnim AC. Safety and technical success of methylene blue dye for lymphatic mapping in breast cancer. Am J Surg 2008; 196: 228-233
    CrossrefPubMedGoogle Scholar
  • 10 Dumbarton TC, Gorman SK, Minor S. et al. Local cutaneous necrosis secondary to a prolonged peripheral infusion of methylene blue in vasodilatory shock. Ann Pharmacother 2012; 46: e6
    PubMedGoogle Scholar
  • 11 Lane KL, Vallera R, Washington K. et al. Endoscopic tattoo agents in the colon. Tissue responses and clinical implications. Am J Surg Pathol 1996; 20: 1266-1270
    CrossrefPubMedGoogle Scholar
  • 12 Mosahebi A, Ramakrishnan V, Gittos M. et al. Aesthetic outcome of different techniques of reconstruction following nipple-areola-preserving envelope mastectomy with immediate reconstruction. Plast Reconstr Surg 2007; 119: 796-803
    CrossrefPubMedGoogle Scholar