Transcutaneous electrical nerve stimulation (TENS) is primarily used for pain reduction and is thought to activate neural fibers modifying vascular resistance and local blood flow influencing flap necrosis. This study aimed to delineate the effects of TENS on the viability of skin flaps created during mastectomy in breast cancer patients. Patients treated with modified radical mastectomy were prospectively randomized to receive either TENS or no further local treatment postoperatively. High frequency (70 Hz) and low intensity (2 mA) TENS was applied and areas of flap ecchymosis and necrosis were measured after the completion of TENS application and compared between the two groups. Patients were also compared according to age, comorbid diseases, duration of anesthesia, flap area, amount of wound drainage and seroma, presence of wound infection and abscess. In addition, local and systemic complications related to TENS were recorded. About 173 patients with a median age of 49 (range 25-87) were included in the study. About 87 patients received TENS whereas 86 patients formed the control group. Patients' characteristics were comparable between the two groups. Number of patients with skin flap necrosis was higher in the control group compared to TENS group (P < 0.0001). Mean area of flap necrosis was significantly lower in TENS group (85.2 +/- 35.9) compared to control group (252.5 +/- 64.1; P = 0.024). Similarly, number of patients with skin flap ecchymosis was higher in the control group compared to TENS group (P = 0.002). However, although mean area of flap ecchymosis was lower in TENS group (105.5 +/- 49.8) compared to control group (172.9 +/- 49.9), this difference did not reach statistical significance (P = 0.34). In addition, there were no local or systemic complications related to TENS application in patients. TENS can be safely used to decrease the amount of skin flap necrosis after mastectomy in breast cancer patients without any additional complication.