Breast reconstruction continues to evolve, with increasing emphasis on improving both clinical outcomes and patient experience. While advances in implant techniques, surgical planning and perioperative care have reduced complication rates, tissue perfusion remains one of the most important factors influencing successful reconstruction.
A recent publication in Clinical Breast Cancer further highlights the importance of optimising tissue viability during implant-based breast reconstruction and reinforces the growing focus on technologies that support intraoperative decision-making.
Why tissue perfusion remains critical
Successful implant-based reconstruction depends on the viability of the mastectomy skin flaps that cover the implant. If blood supply is compromised, patients may experience complications including:
- Mastectomy skin flap necrosis
- Delayed wound healing
- Infection
- Implant exposure
- Implant loss
- Additional corrective surgery
Although experienced surgeons can often identify poorly perfused tissue clinically, visual assessment alone may not always accurately predict postoperative tissue viability.
For this reason, many reconstructive centres are increasingly incorporating objective methods of assessing tissue perfusion during surgery.
Supporting intraoperative decision-making
The publication discusses the continued evolution of reconstructive techniques and the importance of strategies that minimise postoperative complications while maintaining excellent cosmetic outcomes. As reconstructive procedures become increasingly refined, there is growing recognition that objective assessment of tissue viability can complement surgical judgement and support intraoperative decision-making.
Near-infrared fluorescence imaging using indocyanine green (ICG) provides real-time visualisation of tissue perfusion, allowing surgeons to assess blood flow before final implant placement.
Rather than replacing surgical expertise, fluorescence imaging provides additional physiological information that may help identify areas of compromised perfusion that are not always apparent under conventional white-light assessment.
Building on an expanding evidence base
The latest publication adds to an expanding body of literature evaluating strategies to improve outcomes following implant-based breast reconstruction.
Across published studies, investigators continue to explore approaches that may reduce:
- Skin flap complications
- Reoperations
- Implant-related complications
- Length of hospital stay
- Delays to adjuvant therapy
Within this broader context, fluorescence-guided perfusion assessment has become an area of increasing clinical interest, with multiple studies reporting improvements in intraoperative decision-making and reductions in flap-related complications when compared with clinical assessment alone.
The wider clinical picture
Breast reconstruction is increasingly focused not only on restoring anatomy, but also on improving patient outcomes, quality of life and healthcare efficiency.
Reducing postoperative complications may benefit patients through:
- Faster recovery
- Fewer unplanned procedures
- Earlier commencement of adjuvant therapies where required
- Improved aesthetic outcomes
- Greater patient confidence following reconstruction
As reconstructive techniques continue to advance, technologies that provide objective assessment of tissue perfusion are becoming an increasingly valuable component of modern breast surgery.
What does this mean for clinical practice?
This latest publication reflects a broader trend within reconstructive breast surgery towards more personalised, evidence-based intraoperative decision-making.
While careful surgical technique remains fundamental, objective assessment of tissue perfusion is becoming an increasingly important adjunct to clinical judgement. As the evidence base continues to grow, fluorescence imaging with indocyanine green is playing an expanding role in helping surgeons assess tissue viability during implant-based breast reconstruction.
Reference
Clinical Breast Cancer. Recent advances in implant-based breast reconstruction and strategies to optimise surgical outcomes. 2026. Available at: https://www.clinical-breast-cancer.com/article/S1526-8209(26)00075-3/fulltext
