Prediction of Mastectomy Skin Flap Necrosis With Indocyanine Green Angiography and Thermography: A Retrospective Comparative Study

Abstract

Objective: This study investigates the predictive role of indocyanine green angiography and thermography in assessing mastectomy skin flap necrosis in the intraoperative and postoperative setting.

Methods: A retrospective review of 45 patients who underwent nipple-sparing mastectomy and immediate prepectoral reconstruction was performed. Mastectomy flap viability was evaluated intraoperatively with indocyanine green angiography and thermography after placement of an implant sizer and again postoperatively at 24 hours. Fluorescence pattern was analyzed with a near-infrared camera (IC-Flow^TM Imaging System, Diagnostic Green GmbH, Germania) and thermographic images with FLIR ONE device. FLIR ONE and ICG images were then transposed on macroscopic breast images with a scale 1:1. The mastectomy skin flap was evaluated using the SKIN score (Mayo Clinic Classification).

Results: Overlap between angiography and thermography images was 87.95% intraoperatively and 95.95% 24 hours postoperatively. Overlay with mastectomy flap necrosis was higher in the intraoperative angiography group with statistical significance. Contrarily, such a difference was not apparent in the postoperative period.

Conclusions: ICG appears to be a superior tool when used intraoperatively with fundamental implications on reconstructive decision-making, while thermography could be a valuable assessment method in the postoperative setting. Further studies are necessary to confirm such results and determine their clinical applicability.

Keywords: Immediate breast reconstruction; Implant based; Intraoperative assessment; Mastectomy flap necrosis; Postoperative assessment.