Breast Reconstruction

SPY IMAGING IN BREAST RECONSTRUCTION

Breast reconstruction is an option that women undergoing mastectomy for the treatment of breast cancer should consider and discuss with their physician. Breast reconstruction is considered to be a highly safe operation and can be performed using a variety of different techniques depending on a number of factors related to each individual patient. Complications following mastectomy and breast reconstruction have been shown in the literature to occur in up to 20% of woman undergoing breast reconstruction.

The majority of complications can be traced back to poor blood perfusion to the tissue. Complications related to poor perfusion can be physically disfiguring and emotionally devastating, but most importantly, can delay the start of further treatments, such as chemotherapy and radiation. SPY images have been shown to supplement clinical judgement in assessing the quality of perfusion in tissue by allowing the surgeon to visually identify of areas of poor perfusion that can potentially compromise the newly created breast. SPY enables surgeons to treat every woman as an individual and taking all unique factors such as anatomy and previous medical history into account to assist the surgeon in tailoring the procedure to achieve the best possible outcome for every patient. Leading surgeons from highly regarded institutions have reported that SPY imaging has enabled them to significantly reduce, or nearly eliminate, complications in breast reconstruction.

More than 40 published articles in the medical literature feature the clinical and economic benefits of using SPY imaging during mastectomy and breast reconstruction. Use of SPY has been shown in clinical studies to reduce complication rates to virtually zero.2   In a prospective study of 51 tissue expander–implant breast reconstructions published by Philips and colleagues in 2014, the authors concluded that ICG fluorescence angiography (SPY Imaging) is a better predictor of mastectomy skin flap necrosis than fluorescein dye angiography and clinical judgment.

In 2013, Losken et al., published the results of a study comparing mastectomy skin necrosis complication rates and rates and costs associated with unexpected perfusion-related reoperations for 184 patients who underwent breast reconstruction surgery with SPY imaging, versus 184 patients without SPY. Mastectomy skin necrosis rates were lower–13% vs 23% in the patients treated with SPY, with the biggest reduction being severe necrotic complications. As a result, reoperation rates were lower– 5.9% vs 14.1% in the SPY group. Calculated cost savings due to the lower reoperation rate averaged more than $610 per patient.

The Dartmouth Hitchcock Medical Center and Tuck School of Business took the perspective of the third party payer in conducting a cost analysis of the use of SPY in breast reconstruction. The complication rate without SPY was 26.5% compared to 5% when SPY was used. The reduced rate of complications and the calculated value of the gain in Quality of Life, resulted in an approximate $3,500 savings per patient treated with SPY. The authors concluded that SPY angiography is a cost-effective technology under the most stringent acceptable thresholds.

Clinical References

1. Harless CA, Jacobson SR. Tailoring through Technology: A Retrospective Review of a Single Surgeon’s Experience with Implant-Based Breast Reconstruction before and after Implementation of Laser-Assisted Indocyanine Green Angiography. The Breast Journal, 2016 1-8.

2. Murray JD; Jones GE; Elwood ET; Whitty LA; Garcia C. Fluorescent Intraoperative Tissue Angiography with Indocyanine Green: The Evaluation of Nipple-Areolar Vascularity during Breast Reduction Surgery. Plastic and Reconstructive Surgery 2009; 124(4 Suppl):60

3. Phillips BT, Fourman MS, Rivara A, Dagum AB, Huston TL, Ganz JC, Bui DT, Khan SU. Comparing Quantitative Values of Two Generations of Laser-Assisted Indocyanine Green Dye Angiography Systems: Can We Predict Necrosis? ePlasty. Vol 14: 367-377. December 5, 2014.

4. Losken A, Zenn M, Hammel J, Walsh M, Carlson G. Assessment of Zonal Perfusion Using Intraoperative Angiography during Abdominal Flap Breast Reconstruction. Plastic and Reconstructive Surgery. Volume 129, Number 4, April 2012.

5. Chatterjee A, Krishnan NM, Phil M, Van Vliet MM, Powell SG, Rosen JM, Ridgway EB. A Comparison of Free Autologous Breast Reconstruction with and without the Use of Laser-Assisted Indocyanine Green Angiography: A Cost-Effectiveness Analysis. Plast. Reconstr. Surg. 131: 693e, 2013.