Indocyanine green angiography in breast reconstruction: a narrative review

Sufficient tissue perfusion is important in achieving a successful breast reconstruction to provide the patient with an acceptable result in terms of shape, size, symmetry and possible sensation. Indocyanine green angiography (ICG-A) is a well-known imaging modality which can be applied to visualize the per-operative tissue perfusion assisting the surgeon in intraoperative decision making, flap design and trimming. The consequence of using per-operative ICG-A is reported to correlate with a decreased rate of complications and loss of reconstruction; thus, this technique may be a valuable intraoperative assessment tool for the breast reconstructive surgeon. This paper aims to provide a review of the recent knowledge on the use of ICG-A in breast reconstructive procedures. In addition, an evaluation of the favorable application in implant-based reconstruction, oncoplastic techniques and autologous breast reconstruction. The technique is presented with clinical examples illustrated by per-operative videos, photos and assessment of perfusion to provide the reader with a broader perspective on the application and use of ICG-A. There is a need for further standardization of the per-operative application and perfusion assessment using ICG-A in the field of breast reconstruction, also exploring the use of ICG-A in assessment of postoperative monitoring, microvascular anastomoses and venous insufficiency.