Intraoperative Prediction of Mastectomy Skin Flap Necrosis using Standardized ICG Grading and Quantitative…

Cohort studyAnnals of surgical oncology· Jul 2026

Intraoperative Prediction of Mastectomy Skin Flap Necrosis using Standardized ICG Grading and Quantitative Perfusion Mapping.

Alina Yizhuo Shen, Lauren Valentine, Renee Gao … Siba Haykal

Breast ReconstructionCohort studyDiagnosisQ1IF 2.1

Average quantitative perfusion mapping predicted mastectomy skin flap necrosis with AUC 0.792.

Intraoperative Prediction of Mastectomy Skin Flap Necrosis using Standardized ICG Grading and Quantitative Perfusion Mapping.

Alina Yizhuo Shen … Siba Haykal

Annals of surgical oncology · Jul 2026 · Q1 in Surgery

Background

Mastectomy skin flap necrosis (mastectomy skin flap necrosis) remains a common complication after immediate breast reconstruction.

Purpose

This study evaluates a standardized qualitative grading system combined with quantitative perfusion (quantitative perfusion) mapping for intraoperative risk stratification.

Methods

A single-center cohort study was conducted in patients undergoing skin- or nipple-sparing mastectomy with immediate reconstruction.

n = 104 patients

AUC 0.792

Results

AUC 0.792

higher perfusion strongly separated breasts that later necrosed from those that healed

n = 104 patients

More results

The cohort included 185 reconstructions (104 patients), with an mastectomy skin flap necrosis rate of 24.3%.

Mastectomy skin flap necrosis incidence and severity decreased stepwise with improving Yale Grade (p < 0.001).

More results

Breasts with mastectomy skin flap necrosis demonstrated significantly lower quantitative perfusion across all quadrants (p ≤ 0.001), with progressive decline by necrosis severity.

For nipple-areolar complex necrosis, average quantitative perfusion demonstrated the highest accuracy (AUC 0.899).

“

Conclusion · 1 of 2

A standardized indocyanine green grading system combined with quantitative perfusion mapping reliably predicts mastectomy skin flap necrosis.

Conclusion · 2 of 2

Thresholds of average quantitative perfusion ≥ 49 and minimum quantitative perfusion < 33.5, integrated with Yale Grade ≤ 3, provide a practical, tiered framework for intraoperative decision-making.

Intraoperative Prediction of Mastectomy Skin Flap Necrosis using Standardized ICG Grading and Quantitative Perfusion Mapping.

Intraoperative Prediction of Mastectomy Skin Flap Necrosis using Standardized ICG Grading and Quantitative Perfusion Mapping.

Related papers