<< Back to the abstract archive
A prospective study of immediate breast reconstruction with laser-assisted indocyanine green angiography (LAIGA)
Gregory M. Beddell, M.D.,
Shayda Mirhaidari, M.D.,
Marc V. Orlando, M.D.,
Michael G. Parker, M.D.,
John C. Pedersen, M.D.,
Douglas S. Wagner, M.D.
Summa Health System, Akron City Hospital
2015-03-14
Presenter: Gregory M. Beddell, M.D.
Affidavit:
I attest that Gregory Beddell, MD and I jointly conceived this project. Dr Beddell developed the IRB submission, the data collection methodology, performed the data analysis and wrote the abstract. He prepared the Powerpoint presentation. I feel he is responsible for 90% of this project.
Director Name: Douglas S. Wagner, M.D.
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Complication rates following immediate breast reconstruction range from 4-60%, depending on reporting methods. Mastectomy flap necrosis is the sentinel event leading to secondary complications. Our senior surgeon has experienced necrosis in 22.5% of breasts, prior to LAIGA.
Methods: All patients undergoing immediate reconstruction were enrolled. Upon mastectomy completion, the surgeon visually interpreted the skin flaps, performed LAIGA, and intervened if needed. The surgeon completed a postoperative survey based on this data. Patients were followed for ninety days, documenting skin necrosis, infection, seroma, hematoma, implant loss, and reoperation
Results: 104 consecutive patients had 170 immediate reconstructions. Indications for mastectomy included malignancy, BRCA+, and non-BRCA prophylaxis. The overall complication rate was 22.9%. The incidence of necrosis was 12.35%. The total reoperation rate was 9.41%. There was one necrosis-related implant loss. 159 breasts had complete postoperative surveys. 112 breasts had visual and LAIGA interpretation of well or adequately perfused, resulting in 4.47% rate of necrosis, two reoperations, and no implant losses. 17 breasts had visual and LAIGA interpretation of marginal or poor perfusion. Four of these breasts had no intervention because they were nipple-sparing mastectomies. The necrosis rate in this group was 23.53% with no implant losses. 21 breasts had adequate visual interpretation with marginal or poor perfusion on LAIGA. Seven breasts had no intervention. The necrosis rate in this group was 42.86%, with three reoperations for necrosis and one implant loss.
Conclusions: LAIGA more accurately predicts complications from skin flap necrosis. LAIGA is a valuable adjunct to perfusion analysis in immediate breast reconstruction.
