title: Using intraoperative laser angiography to safeguard nipple perfusion in nipple-sparing mastectomies.
abstract: The superior aesthetic outcomes of nipple-sparing mastectomies (NSM) explain their increased use and rising popularity. Fortunately, cancer recurrences involving the nipple-areolar complex (NAC) have been reassuringly low in the range of 1%. Technical considerations and challenges of this procedure are centered on nipple ischemia and necrosis. Patient selection, reconstructive strategies and incision placement have lowered ischemic complications. In this context, rates of full NAC necrosis are 3% or less. The emergence of noninvasive tissue angiography provides surgeons with a practical tool to assess real-time breast skin and NAC perfusion. Herein, we review our classification system of NAC perfusion patterns defined as V1 (from subjacent breast), V2 (surrounding skin), and V3 (combination of V1 + V2). Additionally, we describe the benefits of a first stage operation to devascularize the NAC as a means of improving blood flow to the NAC in preparation for NSM, helping extend the use of NSM to more women. Intraoperative evaluation of skin perfusion allows surgeons to detect ischemia and modify the operative approach to optimize outcomes.
authors.affiliation: 1 Department of Surgery/Section of Surgical Oncology, 2 Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Dua
authors.affiliation: 1 Department of Surgery/Section of Surgical Oncology, 2 Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Bertoni
authors.affiliation: 1 Department of Surgery/Section of Surgical Oncology, 2 Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Dung
authors.initials: D
authors.lastname: Nguyen
authors.affiliation: 1 Department of Surgery/Section of Surgical Oncology, 2 Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Meyer
authors.affiliation: 1 Department of Surgery/Section of Surgical Oncology, 2 Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Gurtner
authors.affiliation: 1 Department of Surgery/Section of Surgical Oncology, 2 Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Irene L
authors.initials: IL
authors.lastname: Wapnir
keywords: Nipple-sparing mastectomy (NSM); breast; ischemia; perfusion; skin necrosis