Identification of Reduced Perfusion and Inflammation in Patients Undergoing Breast Reconstruction with the Use of ICG Fluorescence Angiography

Background: The current evolution of robust population screening, early recognition of breast cancers, and aggressive treatment in all age groups has impacted the focus of long term breast reconstruction expectations for both the patient and the surgeon. Patients actively explore innovative approaches, including gene recognition and prophylactic mastectomies, as well as internet explorations for treatment options, use of hyperbaric oxygen (HBO), nipple salvage, support groups, and heightened positive body images post-operatively. Many surgeons strive to partner with their patients to achieve the most positive physical and psychological outcomes possible. While reconstructive breast surgery post mastectomy may include a permanent prosthesis vs an expander, may be with a patient who is pre or post chemo and/or radiation, and is at sites at high risk of ischemia and inflammation, the challenges to identify potential barriers to achieve the desired outcome exist with every patient. 
HBO protocols to treat flap and nipple ischemia and irradiated tissue hypo perfusion is well documented.

Methods: The addition of Indocyanine Green Fluorescence Angiography (ICGFA) enhances the care available to those experiencing negative inflammatory reactions or reduced blood flow to affected sites and assists in very early recognition of surgical complications. Additionally, ICGFA assists the surgeon to accurately perceive optimal time for expansion fills and amounts. Patient engagement is enhanced with real time visualization to demonstrate progress (or lack thereof) for “better” patient decisions and patients verbalize feeling very supported with immediate feedback. Payors appreciate the measurable demonstration of the need for HBO and the confidence that HBO is appropriately discontinued with evidence of resolution.

Conclusions: ICGFA provides an accurate and serially quantitative measurement of blood flow and identification of the degree of inflammatory involvement in areas of risk and a plan of care that is measurable, engaging, and cost effective.