Indocyanine green guided mastectomy and immediate breast reconstruction

Today, breast cancer is treated, and breast reconstruction is performed in specialized centers. Integrated surgical, oncological and reconstructive treatment and care should characterize the comprehensive pathway. In this setting, the women being diagnosed with breast cancer or genetic disposition thereto, should be offered the highest standard of care and treatment. The prerequisite for a successful reconstruction as well as timely onset of adjuvant treatment is uneventful healing. In addition, this may also yield an aesthetically acceptable or even pleasing result. When performing a breast reconstruction or oncoplasty, adequate viability of the tissues left behind and/or added to partially or totally reconstruct the breast, is of utmost importance for a successful outcome. Therefore, tools to assess tissue perfusion are excellent and valuable instruments for the breast reconstructive surgeon. Indocyanine green-angiography (ICG-A) has been shown to be beneficial in delayed and immediate breast reconstruction. The absolute prerequisite for a successful immediate reconstruction is the nipple-sparing or subcutaneous mastectomy using a sufficient incision to spare the perfusion of the native skin. Upon completion of the mastectomy perfusion assessment is performed and the breast reconstructed, using implants or expanders with or without acellular dermal matrix or autologous flaps. The perfusion of the autologous flap may also be assessed using ICG-A. Depending on the assessment score, the mastectomy flaps or the autologous flap are subsequently revised, thereby increasing the probability of saving the patient post-operative revision and take-back to surgery and thus ensuring uneventful healing.