Subscribe to RSS
DOI: 10.1055/s-0043-1777068
Predicting Nipple Necrosis with a “Lights-on” Indocyanine Green Imaging System: A Report of Two Patients
Funding This study received National Institutes of Health (NIH) grant funding (Project ID: IDAAI6254, Reference number: K20-001).The research reported was supported by the National Cancer Institute of the NIH under award numbers R43CA206754 and R44CA206754.
Authors S.J., T.S., T.K., A.U., and C.L. are employed by OnLume Surgical.
Abstract
Nipple–areolar complex (NAC) necrosis is a devastating complication in nipple-sparing mastectomies (NSMs) that significantly impacts patient's quality of life. The use of fluorescence angiography for intraoperative assessment of mastectomy skin flap perfusion in NSM has been successfully described and can be utilized to help guide surgical decision-making. Recently, a novel fluorescence-guided surgical imager was developed, OnLume Avata System (OnLume Surgical, Madison, WI), which provides intraoperative evaluation of vascular perfusion in ambient light. In this case report, we describe the use of OnLume fluorescence-guided surgery technology to help aid in clinical decision-making for two breast reconstruction cases with concern for intraoperative nipple hypoperfusion.
Keywords
fluorescence imaging - intraoperative - ambient light compatible - breast reconstruction - nipple necrosisAuthors' Contributions
Conceptualization: E.C.S., S.J., C.L., S.O.P.
Funding acquisition: A.U.
Methodology: E.C.S., S.J., S.P.M., S.O.P.
Writing - original draft: E.C.S.
Writing - review & editing: E.C.S., S.P.M., S.J., T.S., T.K., A.U., C.L., S.O.P.
Ethical Approval
IRB approval and subject consent was obtained prior to patient data collection (ID: 2020-0906).
Patient Consent
Informed consent was obtained from both patients to utilize clinical photos and information for this manuscript.
Publication History
Received: 09 May 2023
Accepted: 23 October 2023
Article published online:
04 April 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Venturi ML, Mesbahi AN, Copeland-Halperin LR, Suh VY, Yemc L. SPY elite's ability to predict nipple necrosis in nipple-sparing mastectomy and immediate tissue expander reconstruction. Plast Reconstr Surg Glob Open 2017; 5 (05) e1334
- 2 Algaithy ZK, Petit JY, Lohsiriwat V. et al. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis?. Eur J Surg Oncol 2012; 38 (02) 125-129
- 3 Lee KT, Mun GH. Necrotic complications in nipple-sparing mastectomy followed by immediate breast reconstruction: systematic review with pooled analysis. Arch Hand Microsurg 2014; 23 (02) 51-64
- 4 Parks L. Nipple-sparing mastectomy in breast cancer: impact on surgical resection, oncologic safety, and psychological well-being. J Adv Pract Oncol 2021; 12 (05) 499-506
- 5 Phillips BT, Lanier ST, Conkling N. et al. Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial. Plast Reconstr Surg 2012; 129 (05) 778e-788e
- 6 Duggal CS, Madni T, Losken A. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction. Aesthet Surg J 2014; 34 (01) 61-65
- 7 DSouza AV, Lin H, Henderson ER, Samkoe KS, Pogue BW. Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging. J Biomed Opt 2016; 21 (08) 80901
- 8 Seets T, Shaffrey EC, Kawahara T. et al. An ambient light-compatible, fluorescence-guided surgery imaging platform for real-time clinical assessment of vascular perfusion and flap viability in breast reconstruction. Proc SPIE 2023; 12361: 1236103
- 9 Lauritzen E, Bredgaard R, Bonde C, Jensen LT, Damsgaard TE. An observational study comparing the SPY-Elite ® vs. the SPY-PHI QP system in breast reconstructive surgery. Ann Breast Surg 2023;7. https://abs.amegroups.com/article/view/7299 [Accessed on: 1 May, 2023]
- 10 Kanuri A, Liu AS, Guo L. Whom should we SPY? A cost analysis of laser-assisted indocyanine green angiography in prevention of mastectomy skin flap necrosis during prosthesis-based breast reconstruction. Plast Reconstr Surg 2014; 133 (04) 448e-454e
- 11 Ahn SJ, Woo TY, Lee DW, Lew DH, Song SY. Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy. Eur J Surg Oncol 2018; 44 (08) 1170-1176
- 12 Paprottka FJ, Schlett CL, Luketina R. et al. Risk factors for complications after skin-sparing and nipple-sparing mastectomy. Breast Care (Basel) 2019; 14 (05) 289-296
- 13 Lee KT, Mun GH. Necrotic complications in nipple-sparing mastectomy followed by immediate breast reconstruction: systematic review with pooled analysis. Arch Reconstr Microsurg 2015; 23 (02) 51-64
- 14 Odom EB, Parikh RP, Um G. et al. Nipple-sparing mastectomy incisions for cancer extirpation prospective cohort trial: perfusion, complications, and patient outcomes. Plast Reconstr Surg 2018; 142 (01) 13-26
- 15 Chirappapha P, Petit JY, Rietjens M. et al. Nipple sparing mastectomy: does breast morphological factor related to necrotic complications?. Plast Reconstr Surg Glob Open 2014; 2 (01) e99