Fluorescent intraoperative tissue angiography during breast reduction: a single institution, single surgeon study evaluating decrease in complication rates with acquired proficiency.

Background: Fluorescent intraoperative tissue angiography (FITA) provides real-time perfusion analysis that predicts which tissues will progress to postoperative ischemic necrosis. This technology helps guide the surgeon to resect the at-risk tissues preemptively. The purpose of our study was to evaluate whether clinical outcomes are affected by the level of experience with FITA for superomedial-pedicle breast reduction (SBR).

Methods: A retrospective, sequential series of 50 patients who underwent single-surgeon bilateral reduction mammaplasty using FITA (SPY Elite, Stryker, Kalamazoo, MI, USA) between April 2015 and September 2020 were included in the study. Two groups from the series were formed: the first three years with 25 patients (Group A) and the last three years with 25 patients (Group B). Operative data included FITA perfusion indices (medial breast, lateral breast, and nipple-areolar complex) and resection weight. Post-operative complications such as return to operating room (RTOR), and skin or nipple loss were reported.

Results: Two statistically significant changes were observed: superomedial perfusion indices increased (right breast P<0.001, left breast P=0.02) and resection weights decreased (right breast P=0.044, left breast P=0.007). While the number of observed complications (nipple sensation, minor skin loss, RTOR), decreased in Group B compared to Group A, the difference was not statistically significant (P=0.62). The rate of minor skin or nipple loss was reduced by 57% in Group B versus Group A).

Conclusions: FITA may help guide the preservation of perforators in the breast reduction pedicle. Though doing so did not reveal any statistical reduction in the number of complications in our study. These findings require further investigation for definitive conclusions.