Evaluation of skin viability in nipple sparing mastectomy (NSM)

Abstract

Nipple sparing mastectomy (NSM) is quickly becoming the standard of care due to earlier stage of breast cancer diagnosis, increased prevalence of prophylactic mastectomies, improved surgical techniques, and the desire of women to keep their nipples. However, the procedure is plagued with problems of nipple and skin necrosis due to the inherent ischemic nature of mastectomy. Indocyanine green (ICG) technologies offer surgeons new information that is helpful in the battle to reduce these devastating complications.

Keywords: Nipple sparing mastectomy (NSM); indocyanine green (ICG); necrosis.

Figure 1

A clinical example of SPY’s predictive value. Areas in dark blue on the left were predicted to necrose but the clinical judgment was to leave the skin. The SPY distribution mirrors the areas of ischemia and necrosis seen on the right.

Figure 2

A clinical example of a Zenn Delay, pictured on the left deflated, at 2 weeks after mastectomy and ready for direct-to-implant reconstruction. On the right, 2 months postoperative from a one stage, ADM-supported (DermACELL 16 cm × 20 cm) round smooth silicone gel implant (Mentor) breast reconstruction. Note the nature ptosis and correct nipple position obtainable without intervening months of tissue expansion.