SPY Imaging Use in Postmastectomy Breast Reconstruction Patients: Preventative or Overly Conservative?

Mattison, Gennaya; Lewis, Priya; Gupta, Subhas C.; Kim, Hahns Y.

doi:10.1097/prs.0000000000002266

Cited by 54 publications

(43 citation statements)

References 18 publications

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“…However, this hypothesis is hard to confirm, because objective measures of intraoperative skin flap quality or perfusion are still not available. Some progress has been made using fluorescence angiography. However, fluorescence angiography is not yet recommended as standard care, as at present it is not cost‐effective for use in all patients.…”

Section: Discussionmentioning

confidence: 99%

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

Negenborn

Dikmans

Bouman

et al. 2018

British Journal of Surgery

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BackgroundIn the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct‐to‐implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two‐stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM‐assisted breast reconstruction.MethodsData were obtained from the BRIOS study, including all patients treated with DTI ADM‐assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.ResultsFifty‐nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.ConclusionBreast size appeared to be the most significant predictor of complications in DTI ADM‐assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).

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Section: Discussionmentioning

confidence: 99%

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

Negenborn

Dikmans

Bouman

et al. 2018

British Journal of Surgery

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“…Perfusion systems that guide intraoperative decisions have been advocated but may not always be available. 18 Implant visibility and rippling remains an issue that can be ameliorated but perhaps not always eliminated by fat grafting, despite more cohesive implants. Stability of the footprint of the reconstruction may be more problematic as it depends entirely on stabilization of the ADM pocket on the chest wall and may prove to be an issue with larger implants.…”

Section: Discussionmentioning

confidence: 99%

Animation Deformity in Postmastectomy Implant-Based Reconstruction

Nigro

Blanchet

2017

Plastic and Reconstructive Surgery - Global Open

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“…These analyses can be done either in real time intraoperatively or post hoc. Mattison et al 54 used different thresholds to demonstrate that a higher cut-off value does not necessarily improve sensitivity and may even come at an increased cost in specificity, positive predictive value, and the unnecessary resection of as much as 10 cm 2 or more of skin. As they search for an accurate cut-off, some authors have advocated for the use of relative fluorescence in assessing perfusion, 55,56 but these measurements are more prone to interuser variability than absolute cut-offs.…”

Section: Indocyanine Greenmentioning

confidence: 99%

Intraoperative Perfusion Assessment in Mastectomy Skin Flaps: How Close are We to Preventing Complications?

Khavanin

Qiu

Darrach

et al. 2019

J reconstr Microsurg

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Background Mastectomy flap necrosis is the source of considerable morbidity and cost following breast reconstruction. A great deal of effort has been put forth to predicting and even preventing its incidence intraoperatively. Methods A review of the literature was performed evaluating the evidence of mastectomy skin flap perfusion technologies. Results Multiple technologies have leveraged spectroscopy and/or angiography to provide real-time assessment of flap perfusion, including indocyanine green, fluorescein, and light-based devices. Conclusion This manuscript endeavors to review the evidence on mastectomy skin flap perfusion analysis, highlighting the benefits, and downsides of the current technologies and identifying exciting areas of future research and development.

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SPY Imaging Use in Postmastectomy Breast Reconstruction Patients: Preventative or Overly Conservative?

Abstract: Diagnostic, IV.

Cited by 54 publications

References 18 publications

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

Animation Deformity in Postmastectomy Implant-Based Reconstruction

Intraoperative Perfusion Assessment in Mastectomy Skin Flaps: How Close are We to Preventing Complications?

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