Pure hemi-periareolar incision versus conventional lateral radial incision mastectomy and direct-to-implant breast reconstructions: comparison of indocyanine green angiographic perfusion and necrosis of the nipple
- 주제(키워드) Direct-to-implant breast reconstruction , nipple-sparing mastectomy , indocyanine green , nipple-areola complex necrosis , mastectomy skin flap
- 주제(기타) Surgery
- 설명문(일반) [Park, Jin-Woo; Seong, Ik Hyun; Woo, Kyong-Je] Ewha Womans Univ, Mokdong Hosp, Coll Med, Dept Plast & Reconstruct Surg, Seoul, South Korea; [Lim, Woosung] Ewha Womans Univ, Mokdong Hosp, Coll Med, Dept Surg, Seoul, South Korea
- 등재 SCIE, SCOPUS
- OA유형 Green Published, gold
- 발행기관 AME PUBL CO
- 발행년도 2020
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000175177
- 본문언어 영어
- Published As http://dx.doi.org/10.21037/gs-20-506
- PubMed https://pubmed.ncbi.nlm.nih.gov/33224794
초록/요약
Background: This study evaluated the feasibility of direct-to-implant breast reconstruction after nipple-sparing mastectomy using pure hemi-periareolar incision without extension and with the aid of indocyanine green angiographic evaluation on the mastectomy skin flap. Methods: Patients who underwent immediate direct-to-implant breast reconstruction from December 2018 to February 2020 were included. After nipple-sparing mastectomy, indocyanine green angiographic evaluation of perfusion to nipple-areola complex was performed by video recording with a near infrared camera, and nipple perfusion time and perfusion pattern were analyzed. Patients were divided into a pure hemi-periareolar incision group and conventional lateral radial incision groups to compare nipple perfusion and surgical outcomes. Results: A total of 61 breasts in 56 patients were included. Pure hemi-periareolar incision was used in 41 breasts, and conventional lateral radial incisions were used in 20 breasts. Nipple perfusion time was significantly increased in the pure hemi-periareolar incision group (79.6 +/- 65.8 vs. 43.2 +/- 49.8 seconds, P=0.031). While minor nipple-areola complex necrosis was significantly increased in the pure hemiperiareolar incision group (19.5% versus 0%; P=0.044), major nipple-areola complex necrosis (2.4% versus 5.0%; P>0.999) was not significantly different between the two groups. The rates of nipple-areola complex necrosis were 0%, 16.7%, and 63.6% in rapid, delayed, and no perfusion groups, respectively (P<0.001). No nipple perfusion pattern was a significant predictor for nipple-areola complex necrosis in univariable and multivariable analyses (P<0.001). There was no case of reconstruction failure. Conclusions: Immediate direct-to-implant breast reconstruction after nipple-sparing mastectomy using pure hemi-periareolar incision can be safely performed using indocyanine green angiographic evaluation on the mastectomy skin flap.
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