Utilizing Breast MRI Blood Flow Data to Improve Clinical Outcomes Following Skin Sparing Mastectomy and Nipple Sparing Mastectomy

Karin, Mardi R.; Black, Cara K.; Momeni, Arash

doi:10.1016/j.jamcollsurg.2021.08.037

Cited by 1 publication

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“…We previously evaluated if preoperative contrast-enhanced breast MRI demonstration of vascular anatomy could help guide intraoperative dissection during NSM and facilitate preservation of the dominant IMP to the NAC [15][16][17][18]. In eighty consecutive NSM with immediate reconstruction, pre-operative analysis of breast MRI vascular patterns demonstrated the IMP provided the dominant NAC blood supply in 74% (59/80).…”

Section: Introductionmentioning

confidence: 99%

“…Reoperation for one skin necrosis not involving the NAC (1/80, 1.3%) and one reoperation for epidermolysis near the incision (1.3%, 1/80) occurred. The utility of breast MRI blood flow data to identify the dominant vascular supply to the NAC, thereby, guiding intraoperative dissection for IMP preservation (IMP‐NSM) was demonstrated [15, 17].…”

Section: Introductionmentioning

confidence: 99%

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Nipple Sparing Mastectomy Technique to Reduce Ischemic Complications: Preserving Important Blood Flow Based on Breast MRI

Karin

Pal²,

Ikeda³

et al. 2022

World j. surg.

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Background Nipple‐sparing mastectomy (NSM) with immediate breast reconstruction is commonly performed. However, nipple areolar complex (NAC) and mastectomy skin necrosis represent significant complications requiring reoperation and revision. Breast MRI, often obtained for oncologic assessment, can visualize the dominant breast and NAC vascular supply. This study describes the surgical technique utilizing breast MRI blood flow information to preserve important NAC blood supply, thereby, reducing ischemic complications. Methods After IRB approval, a prospectively maintained database of all NSM by a single breast surgeon from 2018 to 2020 formed the study group. Preoperative contrast enhanced Breast MRI analysis determined the dominant NAC blood supply. Intraoperatively, the dominant Internal Mammary Artery Perforator (IMP) to the NAC was preserved (IMP‐NSM). The IMP‐NSM surgical technique preserving the IMP blood flow, evaluation of breast MRI blood flow patterns, surgical findings, and ischemic complications were analyzed. Results 114 NSM were performed in 74 patients (mean age: 49 years [range, 22–73 years], BMI 25.8 kg/m2 [range, 19–41 kg/m2]). Breast MRI identified the dominant IMP to the NAC in 92%. IMP preservation was successful in 89% (101/114). Necrosis requiring NAC removal occurred in 0.9% (1/114), and skin necrosis reoperation in 1.8% (2/114). Including all post‐operative necrosis occurred in 10.5% (12/114), statistically significantly lower compared to the literature for NSM assessing MRI blood flow data without surgical IMP preservation (necrosis 24.4%, p < 0.001) (Bahl et al. in J Am Coll Surg 223(2):279–285, 2016) utilizing Doppler for IMP preservation (necrosis 37%, p < 0.001) (Swistel et al. in Plast Reconstr Surg Glob Open 2(8):e198, 2014) and dividing the IMP in all (necrosis 31.4%, p < 0.001) (Ahn et al. in Eur J Surg Oncol 44(8):1170–1176, 2018). Conclusions The IMP‐NSM surgical technique preserves the dominant blood supply to the NAC, thereby, decreasing ischemic complications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%