NIPPLE SPARING MASTECTOMY & SENTINEL NODE BIOPSY WITH IMMEDIATE DTI RECONSTRUCTION
Dr. Ram Kalus, MD, FACS
Board-certified plastic surgeon, specializing in immediate implant-based breast reconstruction in both Charleston, SC and Tel Aviv, Israel
CASE HISTORY
A 57-year-old woman with recently discovered left invasive ductal carcinoma (IDC) underwent a left unilateral nipple-sparing mastectomy via an infra-mammary fold (IMF) incision, along with a sentinel node biopsy (SNBx). The breast surgeon used both methylene blue and radio-nucleotide for node identification. SnapshotNIR near-infrared spectroscopy (NIRS) imaging was used to confirm tissue oxygen saturation (StO2) in the mastectomy skin flap intraoperatively.
OBSERVATIONS
After confirming excellent tissue oxygenation in the skin flaps, the patient was reconstructed with a pre-pectoral silicone gel implant with an acellular dermal matrix (ADM) using the "tent" or anterior coverage technique.
FINDINGS
The sentinel node tested negative and the patient did not require adjuvant chemo-therapy or radiation therapy. Her tumor was hormone receptor-positive (ER+ve/PR+ve) and she was placed on hormone therapy.
“By virtue of the ability to assess tissue oxygenation intraoperatively in real-time, with a sizer in place identical to the planned desired permanent implant, a decision was made to proceed with a pre-pectoral DTI reconstruction. ”
PORTABLE FOR ALL POINTS OF CARE IN RECONSTRUCTIVE SURGERY
Preoperative Planning: Quickly and easily assess the wound bed and surrounding tissue without the use of dyes or patient contact.
Interoperative Assessment: Assess surgically manipulated or altered tissue to determine flap viability.
Postoperative Surveillance: Continued surveillance in recovery ensures tissue survival and identification of congested flaps prior to discharge.
Follow-Up Visit Tracking: Evaluate areas of concern to ensure continued positive flap health. The immediate visual data supports the ability to optimize expansion with maximal filling while ensuring tissue viability throughout each visit.
In-Clinic Monitoring: Ability to assess dehisced or slow healing wounds without the need for injections or patient contact.