Fluorescence Imaging in Breast Reconstruction: Minimizing Complications and Improving Outcomes

As the treatment for breast cancer continues to evolve and improve, there is greater patient and surgeon interest in minimizing the morbidity associated with repeat operations, while enhancing breast cosmesis. Nipple-sparing mastectomy combined with expander/implant reconstruction, direct-to-implant reconstruction, or immediate reconstruction with autologous tissue are significant advances in the reconstructive surgeon’s armamentarium in order to restore the natural breast form while minimizing the physical and psychological morbidity associated with repeated operations. Nevertheless, adoption of these techniques has been limited secondary to technical complexity and concern for mastectomy skin flap necrosis. Intraoperative indocyanine green angiography (SPY Elite, Novadaq Technologies Inc., Mississauga, ON) offers a solution to these concerns by providing real-time in-vivo evaluation of skin flap perfusion. Using this technology, the surgeon is able to minimize the morbidity associated with repeat operations due to flap ischemia or congestion and expand the patient population for whom immediate reconstruction following nipple-sparing mastectomy is possible. Here we present our institution’s algorithm and techniques for safe and reliable breast reconstruction following nipple-sparing mastectomy using intraoperative indocyanine green angiography (ICG).