SPY Imaging in Breast Reconstruction Surgery
No Woman Should Face Losing the Same Breast Twice
More than 250,000 American women face the realities of breast cancer each year. More options, advancements in treatments and reconstructive surgery have lead to physical and emotional outcomes that are much different than what they were in the past. For women facing the complete loss of one or both breasts, the advantages of breast reconstruction can be related to self esteem and maintaining a positive body image.
Almost any woman who has undergone breast removal because of cancer can have reconstructive surgery. Reconstructive surgery is considered to be a very safe option, but like any surgery, it is associated with certain risks of complications such as bleeding, fluid build up, poor wound healing and partial or complete tissue death. Serious complications can lead to the loss of the reconstructed breast or need for additional surgery. No woman should suffer losing the same breast twice.
Surgeons report that many of the complications associated with breast reconstruction, can be traced back to poor blood flow in the vessels that deliver blood to tissue or poor circulation in the tissue left behind following the mastectomy. Before SPY, there was no technology available to provide reliable intra-operative information related to blood flow in vessels and circulation in tissue. Surgeons typically relied upon their clinical judgment to determine whether or not blood flow was adequate, but many have expressed concerns that clinical evaluation is not always precise and accurate.
SPY enables surgeons performing breast reconstruction to capture images while in the operating room that allow them to objectively evaluate the quality of blood flow in vessels and tissue. Today, independent studies in breast reconstruction have shown that the use of SPY decreases rates of post operative tissue death and non-healing wounds, returns to surgery and prolonged hospital stays. The ability to assess circulation in tissue, particularly the tissue left behind after mastectomy, might also enable more patients to be candidates for immediate reconstruction.
Frequently asked Questions and Answers
Q: What are the Options for Breast Reconstruction?
A: Breast reconstruction after mastectomy can involve several different types of procedures depending on surgeon and/or patient preference, as well as anatomical issues related to the surgery itself. The most common options include: breast implants which involves placement of tissue expanders after the mastectomy, gradually inflating the expanders over a period of weeks to stretch the skin, and then placing implants at a later date; Deep Inferior Epigastric Perforator (DIEP) flap which involves taking a section of skin and underlying subcutaneous tissue with the supporting blood supply and reimplanting it in the breast position; and Transrectus Abdominal Muscle (TRAM) flap which also involves taking a section of skin and underlying tissue, including muscle, to reimplant in the breast position. With the TRAM flap the blood supply to the flap is sometimes left attached to its native source, and the flap itself is tunneled underneath the skin into the breast position.
Q: How Does SPY Imaging Help Improve the Quality of Breast Reconstruction?
A: In cases where the patient has opted for tissue expanders with subsequent breast implants, SPY allows the surgeon to confirm adequate blood flow into the skin that will cover the tissue expanders.
With flap reconstructions, the entire flap will usually depend on one artery and one vein (perforator artery and vein) for inflow and outflow of its blood supply. The SPY imaging system assists the surgeon in determining which artery and vein will be the best for this purpose. After the newly reconstructed flap is in place, SPY also gives the surgeon real-time confirmation that perfusion of blood to the flap is adequate. Inadequate blood flow into or out of the flap could potentially result in loss of part or all of the flap.
Q: Does SPY Imaging Affect My Recovery?
A: No. Intra-operative imaging does not affect recovery from breast reconstruction surgery. The imaging procedure takes just a few minutes to perform during the operation.
Q: Who Performs SPY Imaging?
A: If you are having a flap reconstruction, your plastic and reconstructive surgeon will first position the SPY camera over your abdomen to determine which perforator vessels will be the best to provide blood flow to and from the flap. The ICG imaging agent is administered, and images of the perforators are immediately displayed and recorded for the team to review. After the flap is placed in the breast position, your surgeon will take additional images by placing the SPY camera over your chest and repeating the earlier injection and recording sequence. With tissue expanders, the same process will be performed over your chest.
Q: Which Hospitals are Performing SPY Imaging for Breast Reconstruction?
A: The number of plastic and reconstructive surgeons using SPY Imaging for breast reconstruction operations continues to grow. Please see our “SPY Locator” to learn about a center near you that performs SPY Imaging.
