title: An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction.
abstract: BACKGROUND
  Intraoperative angiography is a useful tool for predicting both tissue perfusion during postmastectomy breast reconstruction and mastectomy flap and free flap survival.
  
  
  OBJECTIVE
  The authors determine whether the routine use of laser-assisted indocyanine green (ICG) fluorescence angiography (SPY Imaging; LifeCell Corp, Branchburg, New Jersey) in breast reconstruction decreases the incidence of complications and whether this new technology is cost-effective.
  
  
  METHODS
  A retrospective review was conducted for 184 consecutive patients who underwent breast reconstruction using intraoperative ICG angiography from April 2009 to December 2011 at Emory University (Atlanta, Georgia). The incidence of complications (including mastectomy skin necrosis, flap necrosis, fat necrosis, unexpected reoperations, infections, and dehiscence) among these patients was compared with data for 184 consecutive patients who underwent breast reconstruction at Emory University from October 2007 to April 2009, prior to the introduction of ICG angiography. Patient data recorded included age, body mass index, smoking status, and history of preoperative radiation as well as the timing and type of reconstruction, along with complications. The cost of unexpected reoperations for perfusion-related complications and associated hospital stays was calculated.
  
  
  RESULTS
  The 184 patients who underwent procedures using ICG angiography imaging had a lower incidence of mastectomy skin necrosis (13% vs 23.4%; P = .010) and unexpected reoperations for perfusion-related complications (5.9% vs 14.1%, P = .009). The 184 patients who underwent procedures without ICG angiography had a higher mean degree of severity of mastectomy skin necrosis (2.22 vs 1.83 on a scale of 1-3; P = .065). There were no significant differences in the degree of flap necrosis, nipple necrosis, fat necrosis, dehiscence, infection, implant exposure, flap loss, seroma, hematoma, or the number of overall complications between the 2 groups. The use of ICG angiography saved patients an average of $610.
  
  
  CONCLUSIONS
  The use of ICG angiography during postmastectomy breast reconstruction decreased the incidence and severity of mastectomy skin necrosis as well as the incidence of unexpected reoperations for perfusion-related complications. The technology was found to be cost-effective.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, Georgia.
authors.forename: Claire S
authors.initials: CS
authors.lastname: Duggal
authors.forename: Tarik
authors.initials: T
authors.lastname: Madni
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
mesh_terms: D000328:Adult; D001940:Breast / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D005451:Fluorescein Angiography / Q000191:economics; D005456:Fluorescent Dyes; D005845:Georgia / Q000453:epidemiology; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D007208:Indocyanine Green; D007432:Intraoperative Period; D016462:Mammaplasty / Q000009:adverse effects / Q000191:economics; D008408:Mastectomy / Q000009:adverse effects / Q000191:economics; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green
keywords: SPY; breast reconstruction; indocyanine green fluorescence angiography; mastectomy flaps