title: Quantitative assessment of nipple perfusion with near-infrared fluorescence imaging.
abstract: Preserving the nipple-areolar complex with a nipple-sparing mastectomy improves cosmesis compared with skin-sparing mastectomy. However, complications such as necrosis of the nipple-areolar complex significantly affect cosmetic outcome. Many factors influence nipple-areolar perfusion, and no consensus currently exists on optimal incisional choice. This study evaluates 2 nipple-sparing mastectomy incision models using near-infrared fluorescence to assess perfusion quantitatively. The periareolar and radial incisions were compared with 2 control models in Yorkshire pigs (N = 6). Methylene blue and indocyanine green were injected intravenously, and near-infrared fluorescence images were recorded at 3 time points: before surgery, immediately after (0 hour), and 3 days postoperatively. Contrast-to-background ratio was used to assess perfusion. At 72 hours, radial incisions showed a statistically significantly higher perfusion compared with periareolar incisions (P < 0.05). Based on our findings, radial incisions for nipple-sparing mastectomy may be preferable due to higher perfusion; however, clinical trials are necessary for further assessment.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Ashitate
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.forename: Long H
authors.initials: LH
authors.lastname: Ngo
authors.forename: Rita G
authors.initials: RG
authors.lastname: Laurence
authors.forename: Merlijn
authors.initials: M
authors.lastname: Hutteman
authors.forename: Rafiou
authors.initials: R
authors.lastname: Oketokoun
authors.forename: Elaine
authors.initials: E
authors.lastname: Lunsford
authors.forename: Hak
authors.initials: H
authors.lastname: Soo Choi
authors.forename: John V
authors.initials: JV
authors.lastname: Frangioni
mesh_terms: D000818:Animals; D004396:Coloring Agents; D004195:Disease Models, Animal; D005260:Female; D007208:Indocyanine Green; D008408:Mastectomy / Q000379:methods*; D008751:Methylene Blue; D009558:Nipples / Q000098:blood supply* / Q000601:surgery*; D061848:Optical Imaging; D013552:Swine
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green; D008751:Methylene Blue