BREAST Predicting Mastectomy Skin Flap Necrosis with Indocyanine Green Angiography: The Gray Area Defined

Background: Preservation of breast skin during mastectomy has improved the cosmetic results of breast reconstruction. Unfortunately, the incidence of mas-tectomy skin flap necrosis remains high using conventional evaluationmethods; therefore, accurate prediction of flap viability is an important component of postmastectomy reconstruction. Methods: The authors studied a prospective cohort of women who underwent skin-sparingmastectomy andbreast reconstruction over a 2-year period at Emory University. Mastectomy skin flap perfusion was measured intraoperatively using indocyanine green angiography. Once necrosis matured postoperatively, digital images were taken and superimposed over the intraoperative scan. Perfusion percentages were measured in healthy and nonviable skin. Results: One hundred eighteen patients were included, and 14 patients (15 breasts) with postoperative skin necrosis and sufficient image data were ana-lyzed. The average woman’s age was 49.7 years (range, 28 to 73 years) and the average body mass index was 27.7 (range, 21.2 to 42.2). Skin with 25 percent o