A "nipple-saving" imaging machine is helping doctors perform safer, more complex reconstructive surgery for women with breast cancer.
By monitoring blood flow as a woman lies on the operating table, the SPY Elite system could be the difference between high-risk mastectomy patients keeping their nipples or suffering a failed breast reconstruction.
Up to one in 10 breast reconstruction operations result in skin tissue dying - skin necrosis - due to a lack of blood flow. The early signs of skin necrosis cannot be seen with the naked eye.
The SPY fluorescent imaging technology allows surgeons to clearly identify areas of a patient's skin and underlying tissue with low circulation. They can then decide whether to go ahead with more aggressive, nipple-saving surgery; take a more conservative approach; or delay the procedure until the skin has had time to regain circulation.
Patients are injected with a green dye that lights up on the SPY monitors, mapping blood flow to the skin pocket left by mastectomy.
The machine has fundamentally changed the way Associate Professor Sanjay Warrier performs breast reconstructive surgery for many high-risk patients.
"If there is a really large area of the skin with poor blood flow, that can be a catastrophe for the patient," Professor Warrier said.
"[Using SPY] I can be certain that the skin will stay alive after the surgery ??? it has changed my decisions for patients in a significant number of cases," said Professor Warrier, who has trialled the SPY machine over the past year for more than 70 patients at Chris O'Brien Lifehouse.
"It makes the procedure safer and more likely to succeed," he said.
A scan showing the low blood flow in areas of the breasts, before reconstruction surgery. Photo: Janie Barrett
Professor Warrier equated the technology's benefits in surgery with reverse-parking a modern car.
"We have always known how to park, but now we have a rear camera, and a beeper that help guide us. If we've got a wide path behind us these things don't really matter.
"But if you've got kids in the back and it's raining and it's a tight parking space then having that extra technology makes a big difference," he said.
Edith Maling, 59, was diagnosed with invasive lobular carcinoma in 2014 after a mammogram found a four-centimetre tumour in her left breast.
She underwent a mastectomy, chemotherapy and 25 treatments of radiation that damaged her skin and left it vulnerable to skin necrosis and infection.
Professor Warrier, her surgeon, recommended the imaging technology for her reconstructive surgery.
"I felt comfortable knowing I had good circulation on the operating table, " Ms Maling said.
"Previously doctors had to make the call by themselves. Having that extra tool to give them a true reading of circulation gave me confidence."
The SPY surgery is available through private health insurance or public patients can pay out-of-pocket through private surgeon rooms. Lifehouse say they have roughly halved the original cost of $760 per procedure.
The $268,000 machine was paid for with the help of the Sydney Breast Cancer Foundation. Professor Warrier said he hoped the technology would eventually be more widely used in hospitals across Australia. ???