Extensive Mastectomy Skin Flap Necrosis Triggered by Hypertension, Psychological Stress, and Prolonged Operative Time Due to Intraoperative Needle Loss: A Case Report.

Mastectomy skin flap necrosis (MSFN) is a frequent complication influenced by multiple factors. We report a 73-year-old woman with untreated hypertension and preoperative anxiety who developed extensive MSFN after mastectomy. Intraoperative loss of a suture needle prolonged operative time by approximately one hour, contributing to progressive flap necrosis requiring repeated debridement and negative pressure wound therapy. This case was documented to highlight the importance of recognizing how overlooked comorbidities, psychological stress, and intraoperative incidents can interact to exacerbate postoperative complications such as MSFN.