Immediate Breast Reconstruction With Diep Flap ICG Fluorescence

Case History:

53-year-old woman with extensive DCIS carcinoma of the left breast requiring mastectomy and sentinel node dissection.

Immediate breast reconstruction was proposed to the patient who opted for autologous reconstruction with DIEP free flap.

Nipple sparing mastectomy was not possible as the microcalcifications were less than 10 mm from the nipple.

Technique description:

Procedure is performed with a two-team approach.

One team is performing sentinel node dissection, skin sparing mastectomy and recipient vessel dissection while the other team is raising the DIEP flap.

Microsurgical anastomosis is performed at the same time as abdominal donor suite closure.

Procedure steps:

• "Breast" team:
  •  Sentinel node dissection
  • Skin sparing mastectomy with peri areolar approach
  • dissection of internal mammary vein and artery
• "Abdomen" team:
  • DIEP flap dissection
  • Flap vascularization assessment with ICG angiography
  •  Deepithelialisation and trimming of the flap
  •  Flap transfer to the breast and microsurgical anastomosis
• Abdominal donor site closure (like a "Tummy tuck" procedure):
  •  Flap modeling and in-setting to the breast
  •  ICG angiography to assess final vascularization of the mastectomy skin flaps and permeability of the anastomosis.

Trainings Objectives:

This procedure focuses on:

• The benefit of ICG angiography during each step of autologous immediate breast reconstruction
•  DIEP flap harvest
•  Skin sparing mastectomy with sentinel node dissection
• Immediate breast reconstruction