Lee Mi Kyung, Kang Jung-Min, Lim Woo Sung, Park Jin-Woo, Woo Kyong-Je
Aesthet Surg J. 2025 Jan 16;45(2):156-162. doi: 10.1093/asj/sjae218.
Although pure hemi-periareolar incisions for mastectomy can prevent visible scarring, nipple-areolar complex (NAC) necrosis is a potential risk. Superficial-arterial inflow of the NAC can be evaluated by indocyanine green angiography (ICG-A).
This study evaluated the impact of ICG-A-assisted periareolar incision on NAC necrosis during nipple-sparing mastectomy (NSM) and direct-to-implant (DTI) breast reconstruction.
Between December 2018 and November 2021, lateral hemi-periareolar incisions for NSM were routine. After that time, ICG-A-assisted hemi-periareolar incisions were performed between December 2021 and September 2023. The location of the main arterial inflow was evaluated during preoperative ICG-A and the periareolar incision was planned to avoid disruption. NAC necrosis in the ICG-A-assisted and blind-incision groups was compared by univariate and multivariate analyses.
A total of 202 breasts were analyzed, comprising 80 breasts from 75 patients in the ICG-A-assisted group and 122 breasts from 115 patients in the blind-incision group. On preoperative ICG-A, superficial-arterial inflow was observed in 67 of 80 (83.75%) breasts. Perfusion of the nipple without superficial-arterial inflow (base-perfusion pattern) was observed in 13 breasts (16.25%). The main arterial inflow was most common in the upper-medial direction at the areolar margins (65.67%). The full-thickness NAC necrosis rate in the ICG-A-assisted incision group was significantly lower than that in the blind-incision group (2.5% vs 13.1%, P = .010). Multivariate analysis demonstrated that ICG-A-assisted incisions significantly reduced the risk of NAC necrosis (odds ratio, 0.155; P = .030).
ICG-A-assisted pure hemi-periareolar incisions reduced NAC necrosis in DTI breast reconstructions.
虽然单纯的乳晕旁半环形切口用于乳房切除术可避免明显的瘢痕形成，但乳头乳晕复合体（NAC）坏死是一种潜在风险。可通过吲哚菁绿血管造影（ICG-A）评估NAC的浅表动脉血流。
本研究评估了ICG-A辅助乳晕旁切口对保乳乳房切除术（NSM）和即刻乳房重建术（DTI）中NAC坏死的影响。
2018年12月至2021年11月期间，NSM的外侧乳晕旁半环形切口为常规操作。此后，2021年12月至2023年9月期间进行了ICG-A辅助的乳晕旁半环形切口。术前ICG-A期间评估主要动脉血流的位置，并规划乳晕旁切口以避免破坏。通过单因素和多因素分析比较ICG-A辅助组和盲切组的NAC坏死情况。
共分析了202例乳房，其中ICG-A辅助组75例患者的80个乳房，盲切组115例患者的122个乳房。术前ICG-A检查发现，80个乳房中有67个（83.75%）存在浅表动脉血流。13个乳房（16.25%）观察到乳头无浅表动脉血流的灌注（基部灌注模式）。主要动脉血流最常见于乳晕边缘的上内侧方向（65.67%）。ICG-A辅助切口组的全层NAC坏死率显著低于盲切组（2.5%对13.1%，P = 0.010）。多因素分析表明，ICG-A辅助切口显著降低了NAC坏死的风险（优势比，0.155；P = 0.030）。
ICG-A辅助的单纯乳晕旁半环形切口可减少DTI乳房重建术中的NAC坏死。
