Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jul;138(1):15e-21e.
doi: 10.1097/PRS.0000000000002266.

SPY Imaging Use in Postmastectomy Breast Reconstruction Patients: Preventative or Overly Conservative?

Gennaya L Mattison  1   2 , Priya G Lewis  1   2 , Subhas C Gupta  1   2 , Hahns Y Kim  1   2
Affiliations

SPY Imaging Use in Postmastectomy Breast Reconstruction Patients: Preventative or Overly Conservative?

Gennaya L Mattison et al. Plast Reconstr Surg. 2016 Jul.

Abstract

Background: SPY Elite imaging uses an injectable fluorescing agent to intraoperatively assess the perfusion and viability of tissue, including skin flaps, during postmastectomy reconstruction for breast cancer patients. In this study, the authors sought to compare the surgeon's assessment of flap viability with that of SPY imaging perfusion, analyzing the clinical outcomes postoperatively.

Methods: In this study, the intraoperative difference between the plastic surgeon's assessment of skin viability and the SPY imaging assessment was analyzed by the skin flap area preserved in patients undergoing skin-sparing mastectomy. After the mastectomy, the operating surgeon marked the area of the skin flap to excise; then, the SPY imaging was performed and photographs and videos of the perfusion were collected. The skin flap was resected before implant or tissue expander placement according to the plastic surgeon's assessment. The patients were routinely followed up in the clinic postoperatively.

Results: A total of 55 breasts were analyzed. The surface area of diminished perfusion was significantly greater in the SPY imaging compared with the surgeon's assessment.

Conclusions: In this study, intraoperative indocyanine green angiography was found to be conservative in its estimation of viability and, if followed, would result in a more aggressive resection than the area deemed viable by the operating surgeon. Based on the results, intraoperative indocyanine green angiography should be used in settings where perfusion is clinically assessed as marginal. It likely does not play a useful role in lower risk cases where the operating surgeon identifies no areas of concern.

Clinical question/level of evidence: Diagnostic, IV.

PubMed Disclaimer

Comment in

References

    1. Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32:919926.
    1. Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. breast reconstruction: Increasing implant rates. Plast Reconstr Surg. 2013;131:1523.
    1. Gurtner GC, Jones GE, Neligan PC, et al. Intraoperative laser angiography using the SPY system: Review of the literature and recommendations for use. Ann Surg Innov Res. 2013;7:1.
    1. Komorowska-Timek E, Gurtner GC. Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg. 2010;125:10651073.
    1. 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;129:778e788e.