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A Prospective Study of Immediate Breast Reconstruction with Laser-Assisted Indocyanine Green Angiography

Mirhaidari, Shayda J., MD*; Beddell, Gregory M., MD*; Orlando, Marc V., MD*; Parker, Michael G., MD*; Pedersen, John C., MD; Wagner, Douglas S., MD*

Plastic and Reconstructive Surgery – Global Open: September 6, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001774
Latest Articles: PDF Only

Background: Complication rates following immediate breast reconstruction range from 4% to 60%. Mastectomy skin flap necrosis (MSFN) is often the sentinel event leading to secondary complications.

Methods: All patients undergoing immediate reconstruction were enrolled. Upon mastectomy completion, the surgeon visually interpreted the skin flaps, performed laser-assisted indocyanine green angiography (LAIGA), and intervened if needed. Patients were followed for 90 days, documenting skin necrosis, infection, seroma, hematoma, implant loss, and reoperation.

Results: There were 126 patients who had 206 immediate breast reconstructions. The complication rate was 22.3%. The incidence of MSFN was 14.1%. The reoperation rate was 8.7%. There was 1 necrosis-related implant loss. Postoperative surveys were completed on 193 breasts: 137 had visual and LAIGA interpretation of well or adequately perfused, resulting in 5.8% rate of necrosis, 2 reoperations, and no implant losses. Twenty breasts had visual and LAIGA interpretation of marginal or poor perfusion. Sixteen of these underwent intervention. The necrosis rate in this group was 35% with no implant losses. A third group with 26 breasts had adequate visual interpretation with marginal or poor perfusion on LAIGA. Ten breasts had no intervention, and 16 received intervention. The overall necrosis rate in this group was 42.3%, with 4 reoperations for necrosis and 1 implant loss.

Conclusions: LAIGA can more accurately predict complications from MSFN than surgeon assessment alone. When surgeon decision making is supplemented with LAIGA, it reduces the incidence of MSFN, infection, implant loss, and overall unexpected reoperation rate. LAIGA is a valuable adjunct for intraoperative decision making.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Plastic & Reconstructive Surgery, Summa Health System, Akron, Ohio

Plastic & Reconstructive Surgery, Akron General Medical Center, Akron, Ohio.

Published online 6 September 2018.

Received for publication December 15, 2017; accepted March 13, 2018.

Disclosure: Dr. Wagner is a Speaker for LifeCell. The Article Processing Charge was paid for by the authors.

Presented at the American Society of Plastic Surgeons Annual Meeting, October 2015, Boston, Mass; Summa Post Graduate Day, May 2015, Akron, Ohio; and Ohio Valley Society of Plastic Surgeons, May 2015, Covington, Ky.

Shayda Mirhaidari, MD, Plastic & Reconstructive Surgery Department, Summa Health System, Akron City Hospital, 55 Arch St., Suite 2F, Akron, OH 44304, E-mail:

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.