Abstract：
BACKGROUND: Nipple-areola complex (NAC) necrosis is a major complication for breast reconstruction after nipple-sparing mastectomy. Although intraoperative indocyanine green angiography helps to assess the viability of tissue, the imaging could be conservative which may lead to aggressive resection. The plastic surgeons are eager to know the perfusion changes of NAC throughout the perioperative period.
METHODS: In this prospective cohort study, the authors enrolled patients who underwent NSM and immediate direct-to-implant breast reconstruction. All patients underwent laser speckle contrast imaging before surgery, immediately after mastectomy, after implant placement, and 24 h and 72 h after surgery.
RESULTS: A total of 94 breasts were analyzed, including 64 breasts healed with viable NAC and 30 breasts with NAC necrosis. In viable NACs, the average blood supply decreased to 56% after NSM and 42% after reconstruction, then recovered to 68% and 80% at 24-h and 72-h post-operation. In necrotic NACs, the average blood supply decreased to 33% after NSM and 24% after reconstruction, and partial perfusion recovery was also recorded at 24-h (31%) and 72-h (37%) post-operation. The cutoff value for predicting NAC viability is 40% after NSM and 25% after implant placement.
CONCLUSIONS: The study quantified the NAC perfusion changes during the perioperative period. NAC perfusion decreased significantly after NSM and would be the lowest after the end of breast reconstruction. Viable NACs displayed more perfusion during the operation and showed significant nipple revascularization after breast reconstruction.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
METHODS: In this prospective cohort study, the authors enrolled patients who underwent NSM and immediate direct-to-implant breast reconstruction. All patients underwent laser speckle contrast imaging before surgery, immediately after mastectomy, after implant placement, and 24 h and 72 h after surgery.
RESULTS: A total of 94 breasts were analyzed, including 64 breasts healed with viable NAC and 30 breasts with NAC necrosis. In viable NACs, the average blood supply decreased to 56% after NSM and 42% after reconstruction, then recovered to 68% and 80% at 24-h and 72-h post-operation. In necrotic NACs, the average blood supply decreased to 33% after NSM and 24% after reconstruction, and partial perfusion recovery was also recorded at 24-h (31%) and 72-h (37%) post-operation. The cutoff value for predicting NAC viability is 40% after NSM and 25% after implant placement.
CONCLUSIONS: The study quantified the NAC perfusion changes during the perioperative period. NAC perfusion decreased significantly after NSM and would be the lowest after the end of breast reconstruction. Viable NACs displayed more perfusion during the operation and showed significant nipple revascularization after breast reconstruction.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
摘要：
背景：乳头乳晕复合体（NAC）坏死是保留乳头的乳房切除术后乳房再造的主要并发症。虽然术中吲哚菁绿血管造影有助于评估组织的活力，影像学可能是保守的，这可能导致积极的切除。整形外科医生渴望了解整个围手术期NAC的灌注变化。
方法：在这项前瞻性队列研究中，作者纳入了接受NSM和立即直接植入乳房再造的患者.所有患者术前进行激光散斑对比成像,乳房切除术后立即,植入物放置后，术后24h和72h。
结果：共分析了94个乳房，包括64例NAC存活的乳房和30例NAC坏死的乳房。在可行的NAC中，NSM后平均血液供应下降到56%，重建后下降到42%，然后在术后24小时和72小时恢复到68％和80％。在坏死的NAC中，NSM后平均血液供应下降到33%，重建后下降到24%，术后24小时（31％）和72小时（37％）也记录了部分灌注恢复。预测NAC生存力的截止值为NSM后的40%和植入物放置后的25%。
结论：该研究量化了围手术期的NAC灌注变化。NAC灌注在NSM后显著下降，在乳房重建结束后将是最低的。可行的NAC在术中显示出更多的灌注，并且在乳房重建后显示出明显的乳头血运重建。
方法：本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
方法：在这项前瞻性队列研究中，作者纳入了接受NSM和立即直接植入乳房再造的患者.所有患者术前进行激光散斑对比成像,乳房切除术后立即,植入物放置后，术后24h和72h。
结果：共分析了94个乳房，包括64例NAC存活的乳房和30例NAC坏死的乳房。在可行的NAC中，NSM后平均血液供应下降到56%，重建后下降到42%，然后在术后24小时和72小时恢复到68％和80％。在坏死的NAC中，NSM后平均血液供应下降到33%，重建后下降到24%，术后24小时（31％）和72小时（37％）也记录了部分灌注恢复。预测NAC生存力的截止值为NSM后的40%和植入物放置后的25%。
结论：该研究量化了围手术期的NAC灌注变化。NAC灌注在NSM后显著下降，在乳房重建结束后将是最低的。可行的NAC在术中显示出更多的灌注，并且在乳房重建后显示出明显的乳头血运重建。
方法：本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
