BACKGROUND: Nipple-sparing mastectomies (NSM) have gained acceptance in the field of breast oncology. Ischemic complications involving the nipple-areolar complex (NAC) occur in 3-37 % of cases. Skin perfusion can be monitored intraoperatively using indocyanine green (IC-GREEN™, ICG) and a specialized infrared camera-computer system (SPY Elite™). The blood flow pattern to the breast skin and the NAC were evaluated and a classification scheme was developed. METHODS: Preincision baseline and postmastectomy skin perfusion studies were performed intraoperatively using 3 mL of ICG. The pattern of arterial blood inflow was classified according to whether perfusion appeared to originate predominantly from the underlying breast tissue (V1), the surrounding skin (V2), or a combination of V1 and V2 (V3). Ischemia, resection, or delayed complications of NAC were recorded. RESULTS: Thirty-nine breasts were interrogated. Seven (18 %) demonstrated a V1 pattern, 18 (46 %) a V2 pattern, and 14 (36 %) a V3 pattern. Seven (18 %) NACs were removed; six intraoperatively and the seventh in a delayed fashion. Notably, five of the seven resected NACs had a V1 pattern. Overall, 71 % of all V1 cases demonstrated profound ischemic changes by intraoperative clinical judgment and SPY imaging. The rates of resection of the NAC differed significantly between perfusion patterns (Fisher's exact test, p = 0.0003). CONCLUSIONS: Three perfusion patterns for the NAC are defined. The V1 pattern had the highest rate of NAC ischemia in NSM. Imaging NAC and skin perfusion during NSMs is a useful adjunctive tool with potential to direct placement of mastectomy incisions and minimize ischemic complications.
BACKGROUND: Nipple-sparing mastectomies (NSM) have gained acceptance in the field of breast oncology. Ischemic complications involving the nipple-areolar complex (NAC) occur in 3-37 % of cases. Skin perfusion can be monitored intraoperatively using indocyanine green (IC-GREEN™, ICG) and a specialized infrared camera-computer system (SPY Elite™). The blood flow pattern to the breast skin and the NAC were evaluated and a classification scheme was developed. METHODS: Preincision baseline and postmastectomy skin perfusion studies were performed intraoperatively using 3 mL of ICG. The pattern of arterial blood inflow was classified according to whether perfusion appeared to originate predominantly from the underlying breast tissue (V1), the surrounding skin (V2), or a combination of V1 and V2 (V3). Ischemia, resection, or delayed complications of NAC were recorded. RESULTS: Thirty-nine breasts were interrogated. Seven (18 %) demonstrated a V1 pattern, 18 (46 %) a V2 pattern, and 14 (36 %) a V3 pattern. Seven (18 %) NACs were removed; six intraoperatively and the seventh in a delayed fashion. Notably, five of the seven resected NACs had a V1 pattern. Overall, 71 % of all V1 cases demonstrated profound ischemic changes by intraoperative clinical judgment and SPY imaging. The rates of resection of the NAC differed significantly between perfusion patterns (Fisher's exact test, p = 0.0003). CONCLUSIONS: Three perfusion patterns for the NAC are defined. The V1 pattern had the highest rate of NACischemia in NSM. Imaging NAC and skin perfusion during NSMs is a useful adjunctive tool with potential to direct placement of mastectomy incisions and minimize ischemic complications.
Authors: Elizabeth B Odom; Rajiv P Parikh; Grace Um; Simone W Kantola; Amy E Cyr; Julie A Margenthaler; Marissa M Tenenbaum; Terence M Myckatyn Journal: Plast Reconstr Surg Date: 2018-07 Impact factor: 4.730
Authors: Emiliano Cocco; Erik M Shapiro; Sara Gasparrini; Salvatore Lopez; Carlton L Schwab; Stefania Bellone; Ileana Bortolomai; Natalia J Sumi; Elena Bonazzoli; Roberta Nicoletti; Yang Deng; W Mark Saltzman; Caroline J Zeiss; Floriana Centritto; Jonathan D Black; Dan-Arin Silasi; Elena Ratner; Masoud Azodi; Thomas J Rutherford; Peter E Schwartz; Sergio Pecorelli; Alessandro D Santin Journal: Int J Cancer Date: 2015-08-18 Impact factor: 7.396
Authors: Carrie K Chu; Matthew J Davis; Amjed Abu-Ghname; Sebastian J Winocour; Albert Losken; Grant W Carlson Journal: Semin Plast Surg Date: 2019-10-17 Impact factor: 2.314
Authors: Cindy B Matsen; Babak Mehrara; Anne Eaton; Deborah Capko; Anastasia Berg; Michelle Stempel; Kimberly J Van Zee; Andrea Pusic; Tari A King; Hiram S Cody; Melissa Pilewskie; Peter Cordeiro; Lisa Sclafani; George Plitas; Mary L Gemignani; Joseph Disa; Mahmoud El-Tamer; Monica Morrow Journal: Ann Surg Oncol Date: 2015-07-21 Impact factor: 5.344