Annals of Surgical Oncology

, Volume 21, Issue 1, pp 100–106

Intraoperative Imaging of Nipple Perfusion Patterns and Ischemic Complications in Nipple-Sparing Mastectomies

  • Irene Wapnir
  • Monica Dua
  • Anne Kieryn
  • John Paro
  • Douglas Morrison
  • David Kahn
  • Shannon Meyer
  • Geoffrey Gurtner
Breast Oncology

DOI: 10.1245/s10434-013-3214-0

Cite this article as:
Wapnir, I., Dua, M., Kieryn, A. et al. Ann Surg Oncol (2014) 21: 100. doi:10.1245/s10434-013-3214-0

Abstract

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.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Irene Wapnir
    • 1
  • Monica Dua
    • 1
  • Anne Kieryn
    • 1
  • John Paro
    • 1
  • Douglas Morrison
    • 1
  • David Kahn
    • 1
  • Shannon Meyer
    • 1
  • Geoffrey Gurtner
    • 1
  1. 1.Department of SurgeryStanford University School of MedicineStanfordUSA