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Establishing a Predictive Perfusion Threshold Using SPY-PHI QP in Staged Breast Reconstruction: A Prospective
Nikki Rezania1, Kelly A Harmon2, Okensama La-Anyane3
1Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, WI.
Aesthetic Surgery Journal
|May 20, 2026
Summary
Quantitative Perfusion (QP) software aids breast reconstruction by assessing tissue perfusion. A 30% QP threshold may predict complications in patients not using nitroglycerin, guiding surgical decisions.
Area of Science:
- Plastic Surgery
- Surgical Oncology
- Medical Imaging
Background:
- SPY Fluorescence Imaging with Quantitative Perfusion (QP) software offers intraoperative tissue perfusion assessment.
- Establishing reliable perfusion thresholds for predicting mastectomy skin necrosis is crucial but not yet defined.
Purpose of the Study:
- To assess the predictive accuracy of SPY-PHI QP perfusion thresholds in staged breast reconstruction.
- To determine a QP-specific cutoff, considering nitroglycerin ointment as a potential confounding factor.
Main Methods:
- Patients undergoing staged breast reconstruction with tissue expanders were analyzed.
- Intraoperative SPY-PHI QP assessed relative perfusion, with diagnostic metrics calculated.
- A subgroup analysis excluded nitroglycerin use to identify a QP-specific cutoff.
Main Results:
- A 33% QP threshold showed high sensitivity (87.5%) and NPV (98.3%) for flap necrosis.
- Nitroglycerin use attenuated the link between low perfusion and necrosis.
- In non-nitroglycerin patients, a 30% QP threshold yielded optimal performance (100% sensitivity, 76.7% specificity).
Conclusions:
- SPY-PHI QP provides real-time, quantitative perfusion data in breast reconstruction.
- A 30% QP threshold may predict wound complications in patients not using nitroglycerin.
- Further prospective studies are needed to validate QP-specific thresholds, accounting for interventions.