Mapping of the superficial lymphatic network of the breast using indocyanine green injection: an anatomical study

Abstract

Abstract Purpose Indocyanine green (ICG) is a fluorophore that allows exploration of the arterial and lymphatic network. The superficial lymphatic network of the breast is particularly vulnerable in breast augmentation surgery. The intraoperative use of ICG could help the plastic surgeon during breast augmentation surgery. The aim of this work is to demonstrate the feasibility of mapping the superficial breast lymphatic network using ICG. Methods This is an anatomical study. A peri-areolar injection of indocyanine green was performed on cadaveric subjects. At the end, a mapping of their spatial distribution was carried out according to four quadrants, delimited by two perpendicular lines passing by the areola. Results We performed 60 breast injections. The lymphatic network could be identified in 53 of them. A total of 80 vessels were found in the superior-external quadrant, 17 in the superior-internal quadrant, 28 in the inferior-external quadrant and 0 in the inferior-internal quadrant. Conclusion This work shows that indocyanine green allows the identification of the superficial lymphatic network of the breast. Its use could represent an intraoperative assistance in breast augmentation surgery. This work also confirms the existing anatomical notions with a predominance of the axillary drainage route.