School of Medicine and Health Sciences Poster Presentations

Title

Pre-incisional SPY angiography use in nipple and skin sparing mastectomy surgery: An institutional review

Document Type

Poster

Keywords

SPY angiography; nipple sparing mastectomy

Publication Date

5-2017

Abstract

Pre-incisional SPY angiography use in nipple and skin sparing mastectomy surgery: An institutional review

Lawren Wooten B.S., Cecilia Rossi, Sarah Sirajuddin M.D., Anita McSwain M.D., Joanne Lenert, M.D., Christine Teal M.D.

INTRODUCTION: SPY angiography has been widely used to evaluate tissue perfusion in skin and tissue flaps during breast reconstruction. While limited studies have investigated SPY imaging in mastectomy surgery, only one has evaluated the use of SPY to identify the dominant blood supply to the mastectomy flaps and nipple areolar complex (NAC) prior to incision.

OBJECTIVE: To study the intraoperative use of pre-incisional SPY angiography and the ability to identify mastectomy flap and nipple-areolar complex perfusion prior to nipple and skin sparing mastectomies.

METHODS: A retrospective chart review of patients who underwent nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) with intraoperative pre-incisional SPY angiography was performed from August 2016 to October 2016. Study variables included age, reason for surgery, change in incision location, post-operative ischemia, hyperbaric oxygen therapy (HBO), and excision of necrotic tissue. For the purposes of this review, cases were labeled prophylactic when neither breast was cancerous. A case was delineated as therapeutic if mastectomy was only performed on the breast containing cancer or if the patient underwent bilateral mastectomies when one or both breasts were cancerous.

RESULTS: This study included 27 mastectomies in 14 patients with average age of 44.3 ± 11.4 years. Ten cases were defined as prophylactic (71.4%) and 4 cases were defined therapeutic (28.6%). Most cases enabled breast surgeons to identify major perforators during surgery. The location of the planned incision was changed after SPY imaging in one mastectomy (3.7%) due to the location of vasculature. Of the 27 mastectomies, three (11.1%) experienced mastectomy flap or nipple-areolar complex necrosis. One underwent HBO, and all three required subsequent excision of necrotic skin.

CONCLUSIONS: This study describes the possible utility of SPY angiography to identify the dominant perforators supplying the mastectomy flap and nipple areolar complex (NAC). The major limitation is the small number of patients. We recommend larger studies to determine if there is any benefit of having breast surgeons perform SPY angiography prior to performing skin and nipple sparing mastectomies.

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Poster to be presented at GW Research Day 2017.

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Pre-incisional SPY angiography use in nipple and skin sparing mastectomy surgery: An institutional review

Pre-incisional SPY angiography use in nipple and skin sparing mastectomy surgery: An institutional review

Lawren Wooten B.S., Cecilia Rossi, Sarah Sirajuddin M.D., Anita McSwain M.D., Joanne Lenert, M.D., Christine Teal M.D.

INTRODUCTION: SPY angiography has been widely used to evaluate tissue perfusion in skin and tissue flaps during breast reconstruction. While limited studies have investigated SPY imaging in mastectomy surgery, only one has evaluated the use of SPY to identify the dominant blood supply to the mastectomy flaps and nipple areolar complex (NAC) prior to incision.

OBJECTIVE: To study the intraoperative use of pre-incisional SPY angiography and the ability to identify mastectomy flap and nipple-areolar complex perfusion prior to nipple and skin sparing mastectomies.

METHODS: A retrospective chart review of patients who underwent nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) with intraoperative pre-incisional SPY angiography was performed from August 2016 to October 2016. Study variables included age, reason for surgery, change in incision location, post-operative ischemia, hyperbaric oxygen therapy (HBO), and excision of necrotic tissue. For the purposes of this review, cases were labeled prophylactic when neither breast was cancerous. A case was delineated as therapeutic if mastectomy was only performed on the breast containing cancer or if the patient underwent bilateral mastectomies when one or both breasts were cancerous.

RESULTS: This study included 27 mastectomies in 14 patients with average age of 44.3 ± 11.4 years. Ten cases were defined as prophylactic (71.4%) and 4 cases were defined therapeutic (28.6%). Most cases enabled breast surgeons to identify major perforators during surgery. The location of the planned incision was changed after SPY imaging in one mastectomy (3.7%) due to the location of vasculature. Of the 27 mastectomies, three (11.1%) experienced mastectomy flap or nipple-areolar complex necrosis. One underwent HBO, and all three required subsequent excision of necrotic skin.

CONCLUSIONS: This study describes the possible utility of SPY angiography to identify the dominant perforators supplying the mastectomy flap and nipple areolar complex (NAC). The major limitation is the small number of patients. We recommend larger studies to determine if there is any benefit of having breast surgeons perform SPY angiography prior to performing skin and nipple sparing mastectomies.