Two-Stage Implant-Based Breast Reconstruction Using Intraoperative Fluorescence Imaging: A Propensity Score-Matched...

Area of Science:

• Plastic Surgery
• Surgical Oncology
• Medical Imaging

Background:

• Evaluating SPY system fluorescence imaging versus clinical assessment in implant-based breast reconstruction.
• Addressing potential selection and observer bias in efficacy studies.
• Comparing surgical outcomes and complications in the first reconstruction stage.

Purpose of the Study:

• To compare surgical outcomes and complications between SPY system fluorescence imaging and clinical assessment in implant-based breast reconstruction.
• To evaluate the efficacy of intraoperative fluorescence imaging in reducing early complications.
• To identify predictors of wound-related complications in breast reconstruction.

Main Methods:

• Retrospective review of patients undergoing two-stage implant-based breast reconstruction with tissue expanders (TEs) from 2011-2020.
• Propensity score-matched analysis comparing intraoperative fluorescence imaging (SPY system) with clinical assessment.
• Comparison of complication rates, TE-to-implant exchange time, and radiotherapy initiation time.

Main Results:

• After matching 198 reconstructions (99 per group), TE-to-implant exchange and radiotherapy initiation times were comparable.
• Reconstructions evaluated with clinical assessment had significantly higher 30-day wound-related complications (21% vs 9%) and unplanned interventions (16% vs 5%).
• SPY system group had higher 30-day rates of seroma (19% vs 14%) and hematoma (8% vs 0%).

Conclusions:

• Intraoperative fluorescence imaging (SPY system) demonstrated a lower incidence of early wound-related complications compared to clinical evaluation alone.
• The Wise pattern for mastectomy was identified as the sole independent predictor of early wound-related complications.
• While fluorescence imaging shows promise, careful patient selection and surgical technique remain critical.