Arch Aesthetic Plast Surg.  2019 Jan;25(1):1-8. 10.14730/aaps.2019.25.1.1.

Quantitative assessment of nipple perfusion with laser-assisted indocyanine green imaging in nipple-sparing mastectomy with breast reconstruction

• Kim J
• Kim IK
• Jin US
• Chang H

• KMID: 2438786
• DOI: http://doi.org/10.14730/aaps.2019.25.1.1

Abstract

BACKGROUND
It remains unknown whether perfusion mapping using the SPY system can predict mastectomy skin flap necrosis in each type of breast surgery. We analyzed intraoperative indocyanine green (ICG) angiography images of breast cancer patients who underwent nipple-sparing mastectomy (NSM) with implant-based breast reconstruction, and evaluated the perfusion of the nipple-areolar complex (NAC) with the SPY Elite system to predict NAC necrosis with a single quantitative value.
METHODS
We analyzed nipple perfusion in 30 patients from October 2016 to November 2018. After NSM, ICG injection and SPY angiography were performed to characterize NAC perfusion before immediate reconstruction. The nipple perfusion rate was measured by analyzing fluorescence at the central point of the nipple, and the presence of NAC necrosis was evaluated at 5 days and 1 month postoperatively.
RESULTS
Three of the 30 patients developed NAC necrosis that secondarily healed within 1 month, and five developed NAC necrosis and underwent surgical debridement within 1 month. Seven of eight patients with a perfusion rate < 13% developed NAC necrosis, and all four patients with a perfusion rate < 10% needed partial surgical debridement or total NAC excision.
CONCLUSIONS
The nipple perfusion rate could be useful for predicting NAC necrosis before immediate reconstruction. For patients at a high risk for NAC necrosis, tissue expander insertion rather than a direct-to-implant procedure may be considered, and close follow-up with thorough wound management should be done to reduce complications.

Keyword

Mastectomy; Indocyanine green; Nipple; Necrosis

MeSH Terms

Angiography
Breast Neoplasms
Breast*
Debridement
Female
Fluorescence
Follow-Up Studies
Humans
Indocyanine Green*
Mammaplasty*
Mastectomy*
Necrosis
Nipples*
Perfusion*
Skin
Tissue Expansion Devices
Wounds and Injuries
Indocyanine Green