Application of indocyanine green angiography in the selection of implant for breast reconstruction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QU Xiang ¹ , WANG Zihan ² ,  XIE Fang ³ , WU Shanshan ¹ , YANG Xiaobao ¹ , GAO Guoxuan ¹ , XU Wei ¹

1. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P. R. China;
2. Department of Breast Disease, Peking University People’s Hospital, Beijing 100044, P. R. China;
3. Department of Surgery, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, P. R. China;

Corresponding author：

XIE Fang, Email: zhongling126@hotmail.com

Keywords：

breast reconstruction; indocyanine green; dilator; prosthesis implantation

DOI：

10.7507/1007-9424.202209066

Video：

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Objective To analyze the value of indocyanine green (ICG) fluorescence imaging in the evaluation of blood flown of ipple-areola complex (NAC) and implant selection during single-port endoscopic breast reconstruction. Methods From November 2018 to March 2020, 19 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital were retrospectively collected. ICG fluorescence imaging technology was used to evaluate the blood supply pattern and the risk of ischemic necrosis of NAC, so as to guide the selection of implant. At the same time, 14 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital from February 2017 to October 2018 were selected as the historical control group (control group). NAC ischemic necrosis, breast satisfaction and implant removal were compared between the two groups. Results In the ICG group, there were3 cases of V1 pattern and 2 cases of NAC ischemic necrosis (1 case of grade 1, 1 case of grade 2). There was no NAC ischemic necrosis in 16 patients with V2 mode and V3 mode. No implant loss occurred in any of the patients. In the control group, 5 cases had NAC ischemic necrosis (all were severe ischemic necrosis), and 2 cases had implant loss. The rate of severe NAC ischemic necrosis in the ICG group was lower than that in the control group (P<0.01), but there was no significant difference in implant loss rate between the two groups (P=0.17). The breast satisfaction score of the ICG group was higher than that of the control group (P<0.01), but there were no significant difference in satisfaction scores of chestwell-being, psychological well-being and sexual well-being between the two groups (P>0.05). Conclusions ICG imaging can be used to evaluate the blood supply pattern during the operation of prosthetic body mass reconstruction, guide the choice of implant in immediate breast reconstruction, so as to further improve postoperative breast satisfaction.

Citation： QU Xiang, WANG Zihan, XIE Fang, WU Shanshan, YANG Xiaobao, GAO Guoxuan, XU Wei. Application of indocyanine green angiography in the selection of implant for breast reconstruction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(11): 1421-1426. doi: 10.7507/1007-9424.202209066 Copy

1.	Agha RA, Al Omran Y, Wellstead G, et al. Systematic review of therapeutic nipple-sparing versus skin-sparing mastectomy. BJS Open, 2018, 3(2): 135-145.
2.	Falco G, Curcio A, Marongiu F, et al. Bipedicled nipple-sparing mastectomy versus traditional nipple-sparing mastectomy: comparison of 2 alternative techniques in order to save nipple-areola complex. Ann Plast Surg, 2020, 84(4): 366-374.
3.	Toh U, Takenaka M, Iwakuma N, et al. Clinical outcomes of patients after nipple-sparing mastectomy and reconstruction based on the expander/implant technique. Surg Today, 2021, 51(6): 862-871.
4.	Braun SE, Dreicer M, Butterworth JA, et al. Do nipple necrosis rates differ in prepectoral versus submuscular implant-based reconstruction after nipple-sparing mastectomy? Ann Surg Oncol, 2020, 27(12): 4760-4766.
5.	Bezuhly M, Temple C, Sigurdson LJ, et al. Immediate postmastectomy reconstruction is associated with improved breast cancer-specific survival: evidence and new challenges from the Surveillance, Epidemiology, and End Results database. Cancer, 2009, 115(20): 4648-4654.
6.	Racz JM, Harless CA, Hoskin TL, et al. Sexual well-being after nipple-sparing mastectomy: Does preservation of the nipple matter? Ann Surg Oncol, 2022 Apr 6. Epub ahead of print. doi: 10.1245/s10434-022-11578-1.
7.	Chattha A, Bucknor A, Chen AD, et al. Indocyanine green angiography use in breast reconstruction: A national analysis of outcomes and cost in 110, 320 patients. Plast Reconstr Surg, 2018, 141(4): 825-832.
8.	Wapnir I, Dua M, Kieryn A, et al. Intraoperative imaging of nipple perfusion patterns and ischemic complications in nipple-sparing mastectomies. Ann Surg Oncol, 2014, 21(1): 100-106.
9.	高国璇, 王子函, 刘卫华, 等. 单孔充气法腔镜乳房皮下腺体切除术联合一期假体植入乳房重建术临床分析. 中华外科杂志, 2021, 59(2): 121-126.
10.	Fuzesi S, Cano SJ, Klassen AF, et al. Validation of the electronic version of the BREAST-Q in the army of women study. Breast, 2017, 6: 44-49.
11.	Ahn SJ, Woo TY, Lee DW, et al. Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy. Eur J Surg Oncol, 2018, 44(8): 1170-1176.
12.	Kim H, Park SJ, Woo KJ, et al. Comparative study of nipple-areola complex position and patient satisfaction after unilateral mastectomy and immediate expander-implant reconstruction nipple-sparing mastectomy versus skin-sparing mastectomy. Aesthetic Plast Surg, 2019, 43(2): 313-327.
13.	Zarba Meli E, Cattin F, Curcio A, et al. Surgical delay may extend the indications for nipple-sparing mastectomy: A multicentric study. Eur J Surg Oncol, 2019, 45(8): 1373-1377.
14.	Ng YY, Tan VK, Pek WS, et al. Surgical and oncological safety of nipple-sparing mastectomy in an Asian population. Breast Cancer, 2019, 26(2): 165-171.
15.	Seki H, Sakurai T, Mizuno S, et al. A novel nipple-areola complex involvement predictive index for indicating nipple-sparing mastectomy in breast cancer patients. Breast Cancer, 2019, 26(6): 808-816.
16.	Yamada M, Jinno H, Naruse S, et al. Large nipple volume as a risk factor of nipple-areola complex necrosis following nipple-sparing mastectomy. World J Surg, 2022, 46(5): 1116-1121.
17.	Lee JH, Choi M, Sakong Y. Retrospective analysis between complication and nipple areola complex preservation in direct-to-implant breast reconstruction. Gland Surg, 2021, 10(1): 290-297.
18.	Park S, Yoon C, Bae SJ, et al. Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction. Breast, 2020, 53: 85-91.
19.	Ito H, Ueno T, Suga H, et al. Risk factors for skin flap necrosis in breast cancer patients treated with mastectomy followed by immediate breast reconstruction. World J Surg, 2019, 43(3): 846-852.
20.	Cordeiro PG, Albornoz CR, McCormick B, et al. The impact of postmastectomy radiotherapy on two-stage implant breast reconstruction: an analysis of long-term surgical outcomes, aesthetic results, and satisfaction over 13 years. Plast Reconstr Surg, 2014, 134(4): 588-595.
21.	Dikmans RE, Negenborn VL, Bouman MB, et al. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol, 2017, 18(2): 251-258.
22.	Valerio I, Green JM, Sacks JM, et al. Vascularized osseous flaps and assessing their bipartate perfusion pattern via intraoperative fluorescence angiography. J Reconstr Microsurg, 2015, 31(1): 45-53.
23.	刘岩, 穆籣, 李广学, 等. 显微外科血管吻合术中应用吲哚菁绿血管造影评价血管吻合通畅性的价值. 中国医药, 2017, 12(3): 434-437.
24.	Li K, Zhang Z, Nicoli F, et al. Application of indocyanine green in flap surgery: A systematic review. J Reconstr Microsurg, 2018, 34(2): 77-86.
25.	Yoshimatsu H, Karakawa R, Scaglioni MF, et al. Application of intraoperative indocyanine green angiography for detecting flap congestion in the use of free deep inferior epigastric perforator flaps for breast reconstruction. Microsurgery, 2021, 41(6): 522-526.

1. Agha RA, Al Omran Y, Wellstead G, et al. Systematic review of therapeutic nipple-sparing versus skin-sparing mastectomy. BJS Open, 2018, 3(2): 135-145.
2. Falco G, Curcio A, Marongiu F, et al. Bipedicled nipple-sparing mastectomy versus traditional nipple-sparing mastectomy: comparison of 2 alternative techniques in order to save nipple-areola complex. Ann Plast Surg, 2020, 84(4): 366-374.
3. Toh U, Takenaka M, Iwakuma N, et al. Clinical outcomes of patients after nipple-sparing mastectomy and reconstruction based on the expander/implant technique. Surg Today, 2021, 51(6): 862-871.
4. Braun SE, Dreicer M, Butterworth JA, et al. Do nipple necrosis rates differ in prepectoral versus submuscular implant-based reconstruction after nipple-sparing mastectomy? Ann Surg Oncol, 2020, 27(12): 4760-4766.
5. Bezuhly M, Temple C, Sigurdson LJ, et al. Immediate postmastectomy reconstruction is associated with improved breast cancer-specific survival: evidence and new challenges from the Surveillance, Epidemiology, and End Results database. Cancer, 2009, 115(20): 4648-4654.
6. Racz JM, Harless CA, Hoskin TL, et al. Sexual well-being after nipple-sparing mastectomy: Does preservation of the nipple matter? Ann Surg Oncol, 2022 Apr 6. Epub ahead of print. doi: 10.1245/s10434-022-11578-1.
7. Chattha A, Bucknor A, Chen AD, et al. Indocyanine green angiography use in breast reconstruction: A national analysis of outcomes and cost in 110, 320 patients. Plast Reconstr Surg, 2018, 141(4): 825-832.
8. Wapnir I, Dua M, Kieryn A, et al. Intraoperative imaging of nipple perfusion patterns and ischemic complications in nipple-sparing mastectomies. Ann Surg Oncol, 2014, 21(1): 100-106.
9. 高国璇, 王子函, 刘卫华, 等. 单孔充气法腔镜乳房皮下腺体切除术联合一期假体植入乳房重建术临床分析. 中华外科杂志, 2021, 59(2): 121-126.
10. Fuzesi S, Cano SJ, Klassen AF, et al. Validation of the electronic version of the BREAST-Q in the army of women study. Breast, 2017, 6: 44-49.
11. Ahn SJ, Woo TY, Lee DW, et al. Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy. Eur J Surg Oncol, 2018, 44(8): 1170-1176.
12. Kim H, Park SJ, Woo KJ, et al. Comparative study of nipple-areola complex position and patient satisfaction after unilateral mastectomy and immediate expander-implant reconstruction nipple-sparing mastectomy versus skin-sparing mastectomy. Aesthetic Plast Surg, 2019, 43(2): 313-327.
13. Zarba Meli E, Cattin F, Curcio A, et al. Surgical delay may extend the indications for nipple-sparing mastectomy: A multicentric study. Eur J Surg Oncol, 2019, 45(8): 1373-1377.
14. Ng YY, Tan VK, Pek WS, et al. Surgical and oncological safety of nipple-sparing mastectomy in an Asian population. Breast Cancer, 2019, 26(2): 165-171.
15. Seki H, Sakurai T, Mizuno S, et al. A novel nipple-areola complex involvement predictive index for indicating nipple-sparing mastectomy in breast cancer patients. Breast Cancer, 2019, 26(6): 808-816.
16. Yamada M, Jinno H, Naruse S, et al. Large nipple volume as a risk factor of nipple-areola complex necrosis following nipple-sparing mastectomy. World J Surg, 2022, 46(5): 1116-1121.
17. Lee JH, Choi M, Sakong Y. Retrospective analysis between complication and nipple areola complex preservation in direct-to-implant breast reconstruction. Gland Surg, 2021, 10(1): 290-297.
18. Park S, Yoon C, Bae SJ, et al. Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction. Breast, 2020, 53: 85-91.
19. Ito H, Ueno T, Suga H, et al. Risk factors for skin flap necrosis in breast cancer patients treated with mastectomy followed by immediate breast reconstruction. World J Surg, 2019, 43(3): 846-852.
20. Cordeiro PG, Albornoz CR, McCormick B, et al. The impact of postmastectomy radiotherapy on two-stage implant breast reconstruction: an analysis of long-term surgical outcomes, aesthetic results, and satisfaction over 13 years. Plast Reconstr Surg, 2014, 134(4): 588-595.
21. Dikmans RE, Negenborn VL, Bouman MB, et al. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol, 2017, 18(2): 251-258.
22. Valerio I, Green JM, Sacks JM, et al. Vascularized osseous flaps and assessing their bipartate perfusion pattern via intraoperative fluorescence angiography. J Reconstr Microsurg, 2015, 31(1): 45-53.
23. 刘岩, 穆籣, 李广学, 等. 显微外科血管吻合术中应用吲哚菁绿血管造影评价血管吻合通畅性的价值. 中国医药, 2017, 12(3): 434-437.
24. Li K, Zhang Z, Nicoli F, et al. Application of indocyanine green in flap surgery: A systematic review. J Reconstr Microsurg, 2018, 34(2): 77-86.
25. Yoshimatsu H, Karakawa R, Scaglioni MF, et al. Application of intraoperative indocyanine green angiography for detecting flap congestion in the use of free deep inferior epigastric perforator flaps for breast reconstruction. Microsurgery, 2021, 41(6): 522-526.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of indocyanine green angiography in the selection of implant for breast reconstruction

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