Our Summary

This research paper is a systematic review of a technique used to predict and prevent skin tissue death (necrosis) following breast removal surgery (mastectomy). The technique involves using a special dye (indocyanine green or ICG) and a laser to assess blood flow to the skin flaps left after surgery. Poor blood flow can lead to necrosis, which can complicate the healing process and affect the outcome of breast reconstruction.

The researchers searched a scientific database (PubMed) for studies on this topic. They used a specific set of guidelines to review the studies and collected data on the size of the studies, how they were designed, whether they reported on skin flap necrosis, and how they recorded their results.

Of the 51 studies they found, 16 were reviewed in detail. These studies reported a significant decrease in skin necrosis when the ICG technique was used. However, the exact number of units of blood flow that indicates a risk of necrosis varied between studies.

The researchers concluded that the ICG technique is promising in helping surgeons make decisions during surgery to prevent skin necrosis. However, more agreement on how to use and interpret the technique is needed.

FAQs

  1. What is the purpose of the indocyanine green (ICG) technique in mastectomy procedures?
  2. What were the results of the research studies reviewed on the use of the ICG technique?
  3. What are the current limitations or challenges with the use of the ICG technique in preventing skin necrosis after a mastectomy?

Doctor’s Tip

A doctor may advise a patient undergoing mastectomy to discuss with their surgeon the use of the ICG technique to assess blood flow to the skin flaps and potentially prevent skin tissue death. It is important for the patient to be informed about new techniques that can improve the outcome of their surgery and recovery.

Suitable For

Patients who may be recommended for mastectomy include those with:

  1. Breast cancer: Mastectomy may be recommended for patients with early-stage breast cancer, particularly if the tumor is large or located in a difficult-to-treat area.

  2. High risk of breast cancer: Patients with a strong family history of breast cancer or genetic mutations such as BRCA1 or BRCA2 may be recommended for prophylactic mastectomy to reduce their risk of developing breast cancer.

  3. Previous radiation therapy: Patients who have previously undergone radiation therapy to the breast may be at a higher risk of complications if they develop a new breast cancer, leading to a recommendation for mastectomy.

  4. Failed previous breast-conserving surgery: Patients who have had a previous lumpectomy for breast cancer but have had a recurrence or complications may be recommended for mastectomy.

  5. Large breast size: Patients with large breasts may experience difficulty in achieving satisfactory cosmetic outcomes with breast-conserving surgery, leading to a recommendation for mastectomy.

Ultimately, the decision to undergo mastectomy is based on a combination of factors including the individual patient’s medical history, tumor characteristics, and personal preferences. It is important for patients to discuss all available treatment options with their healthcare team to make an informed decision about their care.

Timeline

Before mastectomy:

  • Patient receives a diagnosis of breast cancer or decides to undergo prophylactic mastectomy
  • Patient discusses surgical options with their medical team and decides on mastectomy
  • Patient undergoes pre-operative consultations, tests, and preparations
  • Patient undergoes mastectomy surgery

After mastectomy:

  • Patient wakes up from surgery and begins the recovery process
  • Patient may experience pain, swelling, and limited arm movement
  • Patient stays in the hospital for a few days for monitoring and care
  • Patient is discharged from the hospital and continues recovery at home
  • Patient may undergo additional treatments such as chemotherapy or radiation therapy
  • Patient may consider breast reconstruction options
  • Patient attends follow-up appointments with their medical team for monitoring and support

What to Ask Your Doctor

Questions a patient should ask their doctor about mastectomy and potential skin necrosis prevention techniques:

  1. Can you explain the potential risks of skin tissue death (necrosis) following a mastectomy surgery?
  2. What factors can contribute to poor blood flow to the skin flaps after surgery?
  3. Have you heard of the technique using indocyanine green (ICG) and a laser to assess blood flow to the skin flaps after mastectomy?
  4. How common is skin necrosis after mastectomy, and how do you typically address this issue?
  5. What are the potential benefits of using the ICG technique to prevent skin necrosis?
  6. How would the results of the ICG assessment impact my post-operative care and recovery process?
  7. Are there any specific risks or limitations associated with using the ICG technique during surgery?
  8. How would you interpret the results of the ICG assessment and make decisions during the surgery based on this information?
  9. Are there any alternative techniques or strategies available to prevent skin necrosis after mastectomy?
  10. Can you provide me with more information or resources to learn more about the ICG technique and its potential benefits for my specific case?

Reference

Authors: Driessen C, Arnardottir TH, Lorenzo AR, Mani MR. Journal: J Plast Reconstr Aesthet Surg. 2020 Jun;73(6):1031-1042. doi: 10.1016/j.bjps.2020.02.025. Epub 2020 Feb 18. PMID: 32245733