NonContact Diffuse Optical Assessment of Mastectomy Skin Flaps

1 in 8 U.S. women will develop invasive breast cancer over the course of their lifetime. 35-40% of these women diagnosed annually with breast cancer will be treated with a total mastectomy. From 1998 to 2008, there were 178,603 mastectomies and 51,410 immediate breast reconstructions. The most common complication following prosthesis-based reconstruction is mastectomy skin flap necrosis, due to inadequate perfusion, with incidence rates as high as 10-20%. This can lead to infection, implant exposure and implant loss. There are currently no non-contact methods to simultaneously assess mastectomy skin flap blood flow and oxygenation. A new advanced technology, a non-contact diffuse correlation spectroscopy flow-oximeter, has been recently developed and validated for simultaneous measurement of tissue blood flow and oxygenation. This technology is portable, user friendly and inexpensive and can measure up to 1.5 cm tissue depth. Preliminary studies have shown this technology to be a valid, effective method for measurement of blood flow and oxygenation in local and free tissue transfers. Advantages over currently available technology are that it is non-invasive, can be used take measurements at multiple time points, simultaneously measures blood flow and oxygenation and can measure these parameters beyonf the surface. The goal of this study is to establish and validate the use of this non-contact technology in the prediction of mastectomy skin flap necrosis in both implant based and autologous reconstruction (Aim 1). The non-contact technology will be used to detect blood flow and tissue oxygenation in the breast skin pre-operatively, intraoperatively and post-operatively (Aim 2). The measurement of tissue hemodynamics in this manner will allow for the dynamic measurement of tissue ischemia, and intervention in both the pre-operative and intraoperative setting. Ultimately, this technology. This technology has the potential to further tailor and individualize breast reconstruction, based on pre-operative assessment of breast skin blood flow and oxygenation. Further, a reduction in complication rates leads less emotional burden to the patient, a decrease in the delay of oncologic management and has the potential to decrease the complication rate of immediate breast reconstruction, and its subsequent costs to the healthcare system.