title: Postmastectomy Reconstruction Outcomes After Intraoperative Evaluation with Indocyanine Green Angiography Versus Clinical Assessment.
abstract: Mastectomy flap necrosis is a major complication in patients undergoing tissue expander-based reconstruction. This study compared the complication rates following mastectomy and immediate reconstruction with intraoperative indocyanine green (ICG) angiography evaluation to those with clinical assessment only.
  
  
  
  We performed a single-institution retrospective study of mastectomy patients who underwent immediate tissue expander-based reconstruction between September 2009 and December 2013. ICG angiography was adopted in March 2012. The rates of complications in the ICG and clinical assessment only groups were compared. Factors associated with complications were identified with the Fischer exact test and univariate analysis.
  
  
  
  A total of 114 patients were identified; clinical assessment only, 53 patients; ICG angiography, 61 patients. The overall complication rates were not significantly different between the two groups (ICG angiography, 50.8 %; clinical assessment, 43.4 %; p = 0.46). There was no significant difference in the rates of unexpected return to the operating room, cellulitis, hematomas, and seromas. The overall rates of flap necrosis were not significantly different (ICG angiography, 27.9 %; clinical assessment, 18.9 %; p = 0.28). However, the rates of severe flap necrosis were significantly lower with intraoperative ICG angiography (4.9 %) than with clinical assessment only (18.9 %, p = 0.02). On univariate analysis, breast weight (≥500 g) was significantly associated with increased rates of severe flap necrosis (p = 0.04), whereas body mass index, age, smoking status, prior breast surgery, history of radiation therapy, and receipt of nipple-sparing mastectomy were not.
  
  
  
  We observed that the implementation of intraoperative ICG angiography was associated with a significant decrease in the rate of severe flap necrosis.
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: Gustave K
authors.initials: GK
authors.lastname: Diep
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: Jane Yuet Ching
authors.initials: JY
authors.lastname: Hui
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: Schelomo
authors.initials: S
authors.lastname: Marmor
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Cunningham
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: Umar
authors.initials: U
authors.lastname: Choudry
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Portschy
authors.affiliation: University of Minnesota, Minneapolis, MN, USA. Tuttl006@umn.edu.|Department of Surgery, Minneapolis, MN, USA. Tuttl006@umn.edu.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Tuttle
mesh_terms: D000792:Angiography; D001940:Breast / Q000033:anatomy & histology*; D001943:Breast Neoplasms / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D009929:Organ Size; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green