Intraoperative indocyanine green fluorescence imaging in breast surgery

Background:

Since complications after reconstructive breast surgery are often related to drastic increases of treatment costs and patient suffering several devices were developed in order to prevent them. In this respect, the fluorescence angiography with indocyanine green (ICG) provides promising results by detecting ischemic skin intraoperatively.

Methods:

Women who underwent reconstructive breast surgery at the breast center at Charité between April and December 2017 were included in the analysis. General patient characteristics, medical history, type of surgery as well as postoperative parameters and complications were compared between patients operated using ICG fluorescence angiography and conventionally operated patients.

Results:

Among 68 patients with breast reconstruction 36 (53%) were operated with the ICG angiography device and 32 (47%) without. No significant differences regarding patient demographics, medical history, surgical and reconstructive procedure were found. Wound healing disorders occurred in approx. 13% of the cases in each group. About 12% developed major complications which required revision surgery. Complication rates and the patient reported outcome did not differ significantly. Across both groups, only the risk factor resection weight (≥500 g) was significantly associated with wound healing disorders (RR = 4.55; 95%CI = 1.47 – 13.89; p = 0.048).

Conclusions:

The purchase of a device for intraoperative ICG angiography might not be economical for every hospital and a stringent cost benefit calculation should be done before implementation. We could not demonstrate an improvement in overall outcome and complication rates for our department. Further research regarding the procedure is necessary to better identify patient populations or departments who might benefit from it.