Breast reconstruction following mastectomy has advanced considerably over the past decade, but tissue perfusion remains one of the most important determinants of surgical success. Poorly perfused mastectomy skin flaps can lead to complications including skin flap necrosis, implant loss, delayed wound healing and postponed adjuvant cancer treatment.
A recently published study in the Journal of Clinical Medicine adds to the growing body of evidence supporting the use of indocyanine green (ICG) fluorescence angiography during implant-based breast reconstruction.
Assessing perfusion in real time
The study evaluated 208 women undergoing immediate implant-based breast reconstruction following mastectomy. Surgeons used intraoperative ICG angiography to assess tissue perfusion at multiple stages of the procedure and compared outcomes with a historical control group managed using conventional clinical assessment alone.
ICG angiography demonstrated excellent diagnostic performance for predicting postoperative ischaemic complications and helped identify poorly perfused tissue before reconstruction was completed.
Improved surgical outcomes
Patients undergoing surgery with ICG fluorescence imaging experienced significantly lower complication rates than those assessed by clinical judgement alone.
The study reported reductions in:
- Mastectomy skin flap necrosis
- Seroma formation
- Haematoma
- Upper limb lymphoedema (when combined with axillary reverse mapping)
In addition, patients experienced:
- Shorter hospital stays
- Fewer delays in commencing adjuvant cancer treatment
- Higher aesthetic satisfaction following reconstruction
Why tissue perfusion matters
Visual inspection remains an important component of surgery, but tissue viability is not always obvious under white light. Areas that appear healthy intraoperatively may subsequently develop ischaemia after wound closure.
Near-infrared fluorescence imaging with ICG provides surgeons with additional objective information regarding tissue perfusion, supporting intraoperative decision making where perfusion is uncertain. By identifying compromised tissue before reconstruction is completed, surgeons may be able to reduce postoperative complications associated with inadequate blood supply.
What does this mean for clinical practice?
This publication adds to an expanding evidence base supporting fluorescence-guided assessment of tissue perfusion in breast surgery. Over recent years, numerous studies have evaluated ICG fluorescence imaging across reconstructive breast procedures, with many reporting reductions in skin flap complications and improved surgical outcomes when compared with clinical assessment alone.
As experience with fluorescence-guided surgery continues to grow, intraoperative perfusion assessment is becoming an increasingly important component of modern breast reconstruction.
Reference
Peleașă TM, Nodiți-Cuc A, Andrei RI, et al. The Role of Indocyanine Green Angiography and Axillary Reverse Mapping in Breast Reconstruction Surgery. Journal of Clinical Medicine. 2026;15(4):1638. Available at: The Role of Indocyanine Green Angiography and Axillary Reverse Mapping in Breast Reconstruction Surgery
