{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T20:06:29Z","timestamp":1791057989118,"version":"4.1.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T00:00:00Z","timestamp":1729641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001866","name":"National Research Fund","doi-asserted-by":"publisher","award":["NRF-2022R1F1A1074732"],"award-info":[{"award-number":["NRF-2022R1F1A1074732"]}],"id":[{"id":"10.13039\/501100001866","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Although pure hemi-periareolar incisions for mastectomy can prevent visible scarring, nipple-areolar complex (NAC) necrosis is a potential risk. Superficial-arterial inflow of the NAC can be evaluated by indocyanine green angiography (ICG-A).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>This study evaluated the impact of ICG-A\u2013assisted periareolar incision on NAC necrosis during nipple-sparing mastectomy (NSM) and direct-to-implant (DTI) breast reconstruction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Between December 2018 and November 2021, lateral hemi-periareolar incisions for NSM were routine. After that time, ICG-A\u2013assisted hemi-periareolar incisions were performed between December 2021 and September 2023. The location of the main arterial inflow was evaluated during preoperative ICG-A and the periareolar incision was planned to avoid disruption. NAC necrosis in the ICG-A\u2013assisted and blind-incision groups was compared by univariate and multivariate analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 202 breasts were analyzed, comprising 80 breasts from 75 patients in the ICG-A\u2013assisted group and 122 breasts from 115 patients in the blind-incision group. On preoperative ICG-A, superficial-arterial inflow was observed in 67 of 80 (83.75%) breasts. Perfusion of the nipple without superficial-arterial inflow (base-perfusion pattern) was observed in 13 breasts (16.25%). The main arterial inflow was most common in the upper-medial direction at the areolar margins (65.67%). The full-thickness NAC necrosis rate in the ICG-A\u2013assisted incision group was significantly lower than that in the blind-incision group (2.5% vs 13.1%, P = .010). Multivariate analysis demonstrated that ICG-A\u2013assisted incisions significantly reduced the risk of NAC necrosis (odds ratio, 0.155; P = .030).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>ICG-A\u2013assisted pure hemi-periareolar incisions reduced NAC necrosis in DTI breast reconstructions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of Evidence: 3 (Therapeutic)<\/jats:title>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/asj\/sjae218","type":"journal-article","created":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T19:39:09Z","timestamp":1729712349000},"page":"156-162","source":"Crossref","is-referenced-by-count":4,"title":["Indocyanine Green Angiography\u2013Assisted Pure Hemi-periareolar Incision Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction"],"prefix":"10.1093","volume":"45","author":[{"given":"Mi Kyung","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-min","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woo Sung","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Woo","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7349-6743","authenticated-orcid":false,"given":"Kyong-Je","family":"Woo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,10,23]]},"reference":[{"key":"2025011613014380200_sjae218-B1","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.amjsurg.2016.08.020","article-title":"Trends in mastectomy and reconstruction for breast cancer; a twelve year experience from a tertiary care center","volume":"212","author":"Chang","year":"2016","journal-title":"Am J Surg"},{"key":"2025011613014380200_sjae218-B2","doi-asserted-by":"publisher","first-page":"826e","DOI":"10.1097\/PRS.0000000000004969","article-title":"Incision choices in nipple-sparing mastectomy: a comparative analysis of outcomes and evolution of a clinical algorithm","volume":"142","author":"Frey","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"2025011613014380200_sjae218-B3","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1016\/j.ejso.2018.05.006","article-title":"Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy","volume":"44","author":"Ahn","year":"2018","journal-title":"Eur J Surg Oncol"},{"key":"2025011613014380200_sjae218-B4","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1007\/s00595-020-01975-y","article-title":"Utility of the periareolar incision technique for breast reconstructive surgery in patients with breast cancer","volume":"50","author":"Seki","year":"2020","journal-title":"Surg Today"},{"key":"2025011613014380200_sjae218-B5","doi-asserted-by":"publisher","first-page":"57","DOI":"10.4174\/astr.2020.98.2.57","article-title":"Nipple-sparing mastectomy through periareolar incision with immediate reconstruction","volume":"98","author":"Paek","year":"2020","journal-title":"Ann Surg Treat Res"},{"key":"2025011613014380200_sjae218-B6","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1097\/PRS.0000000000010616","article-title":"A decade of nipple-sparing mastectomy: lessons learned in 3035 immediate implant-based breast reconstructions","volume":"153","author":"Lin","year":"2024","journal-title":"Plast Reconstr Surg"},{"key":"2025011613014380200_sjae218-B7","doi-asserted-by":"publisher","first-page":"e5367","DOI":"10.1097\/GOX.0000000000005367","article-title":"Inframammary versus periareolar incision: a comparison of early complications in nipple-sparing mastectomy","volume":"11","author":"Cavalcante","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2025011613014380200_sjae218-B8","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.breast.2020.06.009","article-title":"Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction","volume":"53","author":"Park","year":"2020","journal-title":"Breast"},{"key":"2025011613014380200_sjae218-B9","doi-asserted-by":"publisher","first-page":"906e","DOI":"10.1097\/PRS.0000000000005502","article-title":"Is there a preferred incision location for nipple-sparing mastectomy? 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