P12 The role of indocyanine green laser angiography in implant-based breast Reconstruction: A systematic review

Abstract

Background and purpose Breast reconstruction is an important part of treatment for women with breast cancer necessitating preservation of the skin envelope during mastectomy. Mastectomy flap necrosis reportedly complicates up to 25% of skin sparing mastectomies and intraoperative evaluation of this flap has traditionally been done by the surgeon. Indocyanine-green angiography (ICG-A) provides an objective assessment of flap perfusion potentially resulting in a reduction in flap loss and wound complications. We performed a systematic review investigating the role of ICG-A in implant-based breast reconstruction, with a particular interest in the reduction in mastectomy flap necrosis. Methods A systematic literature review identified peer-reviewed studies from January 2000 to May 2019 in MEDLINE, EMBASE, Cochrane Library and PubMed reporting complication rates in implant-based reconstruction with and without the use of ICG-A. The database search and screening of suitable abstracts was performed by two authors (VF, IM) and two authors (AC, SW) independently reviewed all suitable articles. Results There was a total of 1212 breast reconstructions from five non-randomised studies comparing rates of flap necrosis before and after implementation of ICG-A. Prior to use of ICG-A, flap necrosis rates ranged from 6.7% - 27%. After institution of ICG-A, this decreased to 0.9% - 14%. Conclusion ICG-A results in a reduction in rates of mastectomy flap necrosis for implant based breast reconstruction and fewer returns to theatre, although this should be further validated in a randomised controlled fashion.