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

Mapping of the superficial lymphatic network of the breast using indocyanine green injection: an anatomical study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mapping of the superficial lymphatic network of the breast using indocyanine green injection: an anatomical study Yannis CLAUDIC, Anne PERRUISSEAU-CARRIER, Charlie DEMARTELEIRE, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2251230/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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. Indocyanine green Breast anatomy Breast lymphatic network Anatomical study Breast augmentation Breast prosthesis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction The lymphatic network of the breast is complex; it was described for the first time by Sappey in the 19th century, using ammonium carminate [ 1 ]. Since then, new methods of exploration have emerged and proven their effectiveness: lymphography, Patent blue colorimetry, lymphoscintigraphy, and lymphofluoroscopy using indocyanine green (ICG)[ 2 ]. ICG is a non radioactive water-soluble fluorophore, approved for clinical use in multiple cases such as retinal vascularization and flap perfusion. When injected, ICG rapidly bounds with plasma proteins with an excitation and emission peak of 780–820 nm when coupled with near infrared imaging [ 3 ]. Its use for the exploration of the lymphatic system has widened in the last 10 years, including for sentinel node research in breast and head and neck cancers [ 4 – 8 ]. Several anatomical studies describe the lymphatic distribution of the breast [ 9 – 12 ]. Classically, four areas are described for lymphatic drainage: axillary, internal mammary, supra- and infra-clavicular. The consensus today is that the main drainage of the breast is the axillary zone [ 1 , 11 – 13 ]. Although no consensus has been reached yet, the lymphatic distribution of the breast is usually considered to consist of two networks: superficial and deep, interconnecting at the subareolar level. From this subareolar plexus, lymphatic channels provide transport to the main draining lymph nodes [ 9 , 10 , 14 ]. Although the physical properties of ICG may not allow for the identification of vascular structures deeper than 2 cm from the skin surface [ 15 – 20 ], ICG might be of interest to help identifying the superficial lymphatic network of the breast and axillary sentinel nodes. Unlike lymphoscintigraphy, ICG does not require any radiation exposure, and does not cause blue staining of the skin as reported with patent blue. The ability to highlight the superficial lymphatic network of the breast could prove to be a valuable aid in plastic surgery, as the placement of breast implants using an axillary approach implies a subcutaneous dissection near this superficial network. Thus, the risk of iatrogenic injury of the lymphatic system is higher and this approach can prove to be detrimental to the detection of the sentinel lymph node for the later management of breast cancer. The use of indocyanine green intraoperatively could be valuable to help plastic surgeons identify lymphatic vessels in the axillary area and therefore better preserve these structures. The purpose of this work is to study the feasibility of mapping the superficial lymphatic network of the breast using ICG. Material This is an observational anatomical study of the diffusion of ICG in the breast after injection at the areolar level in fresh and fresh-frozen female and male anatomic specimens. The excitation and detection of the fluorophore was performed by the Fluobeam® infrared camera from the Fluoptics laboratory. The excitation spectrum of the camera was 750 nm, while the emission spectrum was 800 nm. This study included 30 anatomical specimens, 20 females and 10 males, and resulted in 60 injections. Method Twenty five milligrams of ICG were diluted in 10 ml of 5% glucose solution, and injected subcutaneously. The point of injection was performed 2 cm from the nipple and on 4 points at 12 o'clock, 3 o'clock, 6 o'clock and 9 o'clock (Figs. 1 and 2 ). Specimens were in supine position. After ICG injection, a passive diffusion time of 10 minutes was observed, before massaging of the injection area was performed. The massage manipulation was performed continuously for 5 minutes and in a clockwise direction. Long line diffusion of the fluorophore from the injection site was identified as the presence of a lymphatic vessel. Four quadrants were identified in each breast: superior-internal (internal mammary), superior-external (axillary), inferior-internal and inferior-external. Each vessel found was counted and mapped accordingly to the sector in which it was identified. This analysis of the spatial distribution of the vessels was carried out by two successive and independent observers, on the videos recorded during the experiment with the Fluobeam camera. If no such image was visualized, the result was considered to be a manipulation failure, leading to the exclusion of the subject. Results This study included 30 anatomical specimens, 20 females and 10 males, and resulted in 60 injections. There were 53 lymphatic networks identified (Fig. 3 ) and 7 exclusions due to lack of evidence of the lymphatic network (Fig. 4 ). In total, the average spatial distribution of the dye after massaging distributes as such (Table 1 ): Table 1: Spatial distribution of lymphatic vessels - Upper-lateral quadrant (axillary): 80 vessels (63.9%) (Fig. 5 ) - Upper-medial quadrant (internal mammary): 17 vessels (13.9%) - Lower-lateral quadrant: 28 vessels (22.2%) - Lower-medial quadrant: 0 vessels Discussion The aim of our study was to establish the usefulness of ICG for mapping the superficial lymphatic network of the breast. The results of our work, which shows lymphatic diffusion of ICG in 53 of the 60 injections performed, demonstrated the feasibility of identifying mammary lymphatic vessels using ICG injections. We assumed that the images obtained corresponded to the lymphatic network and not to the arteriovenous system because of previous anatomical studies showing that the latter does not overlap with the lymphatic network [ 21 – 24 ]. Thus, the mapping of the mammary arteriovenous system would be significantly different from the lymphatic system and would not produce superimposable images [ 25 – 27 ]. ICG is now a common tool for the exploration of the arteriovenous system [ 28 – 30 ]. Its use for lymphatic network exploration benefits from the cadaveric study of Shinaoka et al [ 31 ] who mapped the lymphatic network of the limbs after subcutaneous injection of the dye in the hands and feet. This anatomical study was then confirmed in vivo by the work of Unno et al. [ 32 , 33 ]. However, ICG has a low radiation intensity which limits its use for the detection of deep lymphatic vessels because infrared cameras cannot detect radiation deeper than 2 cm [ 32 ]. The results obtained in this work are therefore limited to the superficial lymphatic network. Subsequently, the use of ICG seems to be of less interest in obese subjects or in areas with a large amount of fat such as the breast. Therefore, it doesn’t have any use for the detection of deep lymph nodes when searching for the sentinel lymph node. In order to overcome these limitations, Yamashita et al suggest to apply a transparent material to the study area to enhance the detection of radiation by vitro pressure [ 34 ]. Schaafsma et al. suggest the combination of ICG and technetium to form a hybrid tracer providing greater spatial resolution [ 8 ]. We chose to include both male and female subjects in this study. Although anatomical studies of the male breast are rare in the literature, they show that the vascularity of the breast is similar between men and women [ 26 , 35 ]. In addition, axillary prosthetic breast augmentation surgery is equally applicable to women for cosmetic purposes as it is to men during sex reassignment surgery. The topographical analysis of the superficial lymphatic vessels revealed by the ICG injection shows that they are predominantly distributed in the superior-external quadrant, corresponding to the axillary zone. This analysis is consistent with previous anatomical studies of the mammary lymphatic network [ 1 , 11 , 14 , 36 ]. Previous anatomical studies describe two lymphatic networks in the breast: superficial and deep [ 10 , 11 , 14 ]. Our findings strongly suggest the predominance of the superficial lymphatic network of the breast, which seems to be the main contributor to lymphatic drainage to the axillary lymphnode, confirming Sappey’s findings. Sappey described a primary centripetal lymphatic drainage to the subareolar plexus via the deep network, then, secondarily, the lymph travels to the superficial network to reach the axillary lymph nodes [ 36 , 37 ]. We noticed during the experiments that the vessels belonging to the upper external quadrant run in the direction of the axillary fossa, without actually ever reaching it. This phenomenon confirms various studies [ 38 – 41 ] reporting an anatomical zone located behind the lateral edge of the pectoralis major, near the lower pole of the axillary fossa, where the lymph nodes responsible for breast drainage are concentrated: the "Soft Tissue Triangle" (Fig. 6 and Fig. 7 ). This area is located at a distance from the axillary approach, which is used for prosthetic augmentation. As this is an original study of mammary lymphatic circulation in the cadaveric subject, there is no previous work regarding the optimal amount to be injected. We based our study on the results of Murawa et al [ 6 ] who showed that the level of fluorescence obtained was directly correlated to the dose injected. Therefore, as this was a cadaveric study, we chose to inject a whole dose of infracyanin, i.e. 25 mg of product, in order to potentiate the fluorescence capabilities of the ICG. This amount may need to be adjusted for in vivo lymph nodes detection. The study of lymphatic circulation in anatomical subjects suffers from an important limitation related to the absence of tissue perfusion pressure. In vivo, lymph flow through vessels is governed by both intrinsic factor, the spontaneous contractility of endothelial cells and extrinsic factors: muscle contraction, perfusion pressure, respiratory amplitude for thoracic lymph vessels [ 42 ]. We based our protocol on various previous works using massage to enhance ICG diffusion in cadavers [ 17 , 18 , 31 , 33 ] and described passive diffusion time after dye injection during which the diffusion of ICG within the lymphatic vessels was related solely to the mechanical pressure induced by the syringe. Massaging of the injection site was performed afterwards to theoretically reproduce the effect exerted by the cardiac pump under physiological conditions. However, several limitations to this study should be noted. Amongst the 60 breast injections performed, only 53 were usable. There was some heterogeneity among the subjects. The sex ratio was unbalanced (10 men and 20 women), and the state of preservation was not identical amongst all subjects. The study included only 8 "fresh" subjects, i.e. deceased for less than 72 hours and never frozen. The 7 excluded breasts in which it was not possible to detect lymphatic vessels were characterized by the formation of a diffusion "cloud" at the dye injection site (Fig. 4 ). Two hypothesis can be proposed: a degradation of the mammary lymphatic network in the cadaver or a handling mistake during the injection leading to a deeper penetration of the dye not allowing its absorption by the subareolar plexus of the anatomical subjects. Interestingly, one of the excluded breasts belonged to a subject in which a satisfactory result was obtained on the contralateral breast, inciting us not to neglect the possibility of a handling mistake. Conclusion The value of ICG for the study of skin perfusion is now well recognized and its use for the study of lymphatic vessels is in full development. Our work shows that ICG is an effective tracer for mapping the superficial lymphatic network of the breast and our results regarding lymphatic networks of the breast are consistent with those of the existing literature. Its intraoperative use in breast augmentation surgery would allow for better control of subcutaneous dissection and help preserve the integrity of the lymphatic network. However, the inherent limitations of any cadaveric study do not allow us to extrapolate these results to the living. An in vivo study will be required to confirm these results. Declarations The authors have no personal, Financial or institutional interest in any of the drugs, materials or devices describes in this article Acknowledgments The authors would like to thank the people who donated their bodies for making this study possible and for improving medical knowledge. Ethical Approval : Not applicable Competing interests : The authors declare that they have no ties of interest. Authors contributions : 1 : Y CLAUDIC : Data collection, writing and protocol development 2 : A PERRUISSEAU-CARRIER : Manuscrit editing 3 : Charlie DEMARTELEIRE : Manuscrit editing 4 : Weiguo HU : Manuscrit editing and protocol development 5 : Romuald SEIZEUR : Manuscrit editing and protocol development Funding : Not applicable Availability of data and materials The data are available upon request to the corresponding author References Salmon RJ, Montemagno S, Laki F, Alran S, Charitansky H, Fourchotte V, et al. Réseaux lymphatiques de la glande mammaire : l’identification du ganglion sentinelle revue à la lumière des anciens anatomistes. Journal de Chirurgie 2007;144:72–4. https://doi.org/10.1016/S0021-7697(07)89473-7. Riquet M, Becker C, Mordant P, Arrivé L. Explorations du système lymphatique : épreuve au bleu, lymphographies directes, lymphoscintigraphies et autres méthodes 2019:13. Benson RC, Kues HA. Fluorescence properties of indocyanine green as related to angiography. 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Physiologie de la circulation lymphatique 2019:12. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2251230","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":150650547,"identity":"9ca87c4e-7caf-47f1-ae83-807d0750a331","order_by":0,"name":"Yannis CLAUDIC","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYLCCBCDmA2KJBAYbIMXYeIAoLWwQLWkgLQ2EtTDAtDAwHAZz8GoxOH722IMHfxjk2djPGN54UHPebm37YaAtNTbROLWcyUs3SGxjMGzjyTG2SDh2O3nbmUSglmNpuQ24tBzIMZNIbGBIYGMAM24nmx0AamFsOIxby/k3ZhIJf4Ba+N+AtJxLNjv/kICWG0DDgVYksEmAbTlgZ3aDgC2SN0CGt0kYtkk8Kwb6JTnB7AbQlgQ8fuE7n2Mm+eOPjTw/f/LGmz9q7OzNzqc/fPChxganFoUDYEoCLpAIVpmAQzkIyKObZY9H8SgYBaNgFIxQAAD25F/cPlPAVQAAAABJRU5ErkJggg==","orcid":"","institution":"Centre Hospitalier Régional Universitaire de Brest","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yannis","middleName":"","lastName":"CLAUDIC","suffix":""},{"id":150650548,"identity":"ccf739da-f88d-4c51-a5ff-90177efb45d6","order_by":1,"name":"Anne PERRUISSEAU-CARRIER","email":"","orcid":"","institution":"Centre Hospitalier Régional Universitaire de Brest","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anne","middleName":"","lastName":"PERRUISSEAU-CARRIER","suffix":""},{"id":150650551,"identity":"9c831f53-0f46-4223-8808-0731f28cadfb","order_by":2,"name":"Charlie DEMARTELEIRE","email":"","orcid":"","institution":"Centre Hospitalier Régional Universitaire de Brest","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Charlie","middleName":"","lastName":"DEMARTELEIRE","suffix":""},{"id":150650552,"identity":"ac6c16f9-30fa-4917-8d67-003c6ade2743","order_by":3,"name":"Weiguo HU","email":"","orcid":"","institution":"Centre Hospitalier Régional Universitaire de Brest","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Weiguo","middleName":"","lastName":"HU","suffix":""},{"id":150650553,"identity":"9907e2cd-9328-4225-8252-47f29b59a4a8","order_by":4,"name":"Romuald SEIZEUR","email":"","orcid":"","institution":"Centre Hospitalier Régional Universitaire de Brest","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Romuald","middleName":"","lastName":"SEIZEUR","suffix":""}],"badges":[],"createdAt":"2022-11-08 12:59:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2251230/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2251230/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":29029974,"identity":"4762c391-d3fa-436c-83ea-2db4a0092644","added_by":"auto","created_at":"2022-11-14 15:07:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22097866,"visible":true,"origin":"","legend":"\u003cp\u003eSubcutaneous injection\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2251230/v1/9862b4c2c5a2158a1ef22355.png"},{"id":29029973,"identity":"f1f5790e-58c3-4d60-8622-c2ae0279abbc","added_by":"auto","created_at":"2022-11-14 15:07:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":169018,"visible":true,"origin":"","legend":"\u003cp\u003eInfrared view of the areola immediately after ICG injection. Right Breast.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-2251230/v1/de77b6f6a8885d14faa90644.png"},{"id":29029969,"identity":"dc6801bd-0cc1-4475-ace2-d0ac1619313f","added_by":"auto","created_at":"2022-11-14 15:07:21","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":225785,"visible":true,"origin":"","legend":"\u003cp\u003eLymphatic vessels. Right breast.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-2251230/v1/529f99b8ddf7455e020c4d7c.png"},{"id":29030737,"identity":"94852237-f234-4eca-be8a-301d93eaa35b","added_by":"auto","created_at":"2022-11-14 15:15:21","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":197184,"visible":true,"origin":"","legend":"\u003cp\u003eInfrared view of the areola with no visualization of the lymphatic vessels. Right Breast.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-2251230/v1/4dad2a45e76747aa1e1c4efb.png"},{"id":29032221,"identity":"e26c90ad-535c-4ca7-9c7b-027b6e5d5c2f","added_by":"auto","created_at":"2022-11-14 15:23:21","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":315832,"visible":true,"origin":"","legend":"\u003cp\u003eInfrared view of the axillary lymphatic vessels. Right breast.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-2251230/v1/e13e85726c5cb3ca0bbcca6e.png"},{"id":29030739,"identity":"ba43217a-c16f-4aed-8bae-9ea25c25758a","added_by":"auto","created_at":"2022-11-14 15:15:22","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":24369095,"visible":true,"origin":"","legend":"\u003cp\u003e« Soft Tissue Triangle » skin projection, at distance from the axillary approach\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-2251230/v1/1542426b460bb1bb48bd6f99.png"},{"id":29029970,"identity":"51b274ce-316e-4bc2-b710-a7365e55c57c","added_by":"auto","created_at":"2022-11-14 15:07:21","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":295444,"visible":true,"origin":"","legend":"\u003cp\u003eInfrared view of the axillary lymphatic vessels at a distance from the axillary approach. Right Breast.\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-2251230/v1/508bd7cabdc91ab349ec15f7.png"},{"id":30075359,"identity":"c34ae360-43cf-4e87-830d-70386260e657","added_by":"auto","created_at":"2022-12-08 16:14:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5376325,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2251230/v1/5d5db5e3-fb03-48fa-802a-b9514571fe86.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mapping of the superficial lymphatic network of the breast using indocyanine green injection: an anatomical study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe lymphatic network of the breast is complex; it was described for the first time by Sappey in the 19th century, using ammonium carminate [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Since then, new methods of exploration have emerged and proven their effectiveness: lymphography, Patent blue colorimetry, lymphoscintigraphy, and lymphofluoroscopy using indocyanine green (ICG)[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. ICG is a non radioactive water-soluble fluorophore, approved for clinical use in multiple cases such as retinal vascularization and flap perfusion. When injected, ICG rapidly bounds with plasma proteins with an excitation and emission peak of 780\u0026ndash;820 nm when coupled with near infrared imaging [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Its use for the exploration of the lymphatic system has widened in the last 10 years, including for sentinel node research in breast and head and neck cancers [\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral anatomical studies describe the lymphatic distribution of the breast [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Classically, four areas are described for lymphatic drainage: axillary, internal mammary, supra- and infra-clavicular. The consensus today is that the main drainage of the breast is the axillary zone [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Although no consensus has been reached yet, the lymphatic distribution of the breast is usually considered to consist of two networks: superficial and deep, interconnecting at the subareolar level. From this subareolar plexus, lymphatic channels provide transport to the main draining lymph nodes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the physical properties of ICG may not allow for the identification of vascular structures deeper than 2 cm from the skin surface [\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], ICG might be of interest to help identifying the superficial lymphatic network of the breast and axillary sentinel nodes. Unlike lymphoscintigraphy, ICG does not require any radiation exposure, and does not cause blue staining of the skin as reported with patent blue.\u003c/p\u003e \u003cp\u003eThe ability to highlight the superficial lymphatic network of the breast could prove to be a valuable aid in plastic surgery, as the placement of breast implants using an axillary approach implies a subcutaneous dissection near this superficial network. Thus, the risk of iatrogenic injury of the lymphatic system is higher and this approach can prove to be detrimental to the detection of the sentinel lymph node for the later management of breast cancer. The use of indocyanine green intraoperatively could be valuable to help plastic surgeons identify lymphatic vessels in the axillary area and therefore better preserve these structures.\u003c/p\u003e \u003cp\u003eThe purpose of this work is to study the feasibility of mapping the superficial lymphatic network of the breast using ICG.\u003c/p\u003e"},{"header":"Material","content":"\u003cp\u003eThis is an observational anatomical study of the diffusion of ICG in the breast after injection at the areolar level in fresh and fresh-frozen female and male anatomic specimens.\u003c/p\u003e \u003cp\u003eThe excitation and detection of the fluorophore was performed by the Fluobeam\u0026reg; infrared camera from the Fluoptics laboratory. The excitation spectrum of the camera was 750 nm, while the emission spectrum was 800 nm.\u003c/p\u003e \u003cp\u003eThis study included 30 anatomical specimens, 20 females and 10 males, and resulted in 60 injections.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eTwenty five milligrams of ICG were diluted in 10 ml of 5% glucose solution, and injected subcutaneously. The point of injection was performed 2 cm from the nipple and on 4 points at 12 o'clock, 3 o'clock, 6 o'clock and 9 o'clock (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Specimens were in supine position.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAfter ICG injection, a passive diffusion time of 10 minutes was observed, before massaging of the injection area was performed. The massage manipulation was performed continuously for 5 minutes and in a clockwise direction.\u003c/p\u003e \u003cp\u003eLong line diffusion of the fluorophore from the injection site was identified as the presence of a lymphatic vessel.\u003c/p\u003e \u003cp\u003eFour quadrants were identified in each breast: superior-internal (internal mammary), superior-external (axillary), inferior-internal and inferior-external. Each vessel found was counted and mapped accordingly to the sector in which it was identified. This analysis of the spatial distribution of the vessels was carried out by two successive and independent observers, on the videos recorded during the experiment with the Fluobeam camera.\u003c/p\u003e \u003cp\u003eIf no such image was visualized, the result was considered to be a manipulation failure, leading to the exclusion of the subject.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included 30 anatomical specimens, 20 females and 10 males, and resulted in 60 injections. There were 53 lymphatic networks identified (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) and 7 exclusions due to lack of evidence of the lymphatic network (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn total, the average spatial distribution of the dye after massaging distributes as such (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e\n\u003cp\u003eTable 1: Spatial distribution of lymphatic vessels\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab1\"\u003e\u003c/table\u003e\n\u003cp\u003e- Upper-lateral quadrant (axillary): 80 vessels (63.9%) (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003e- Upper-medial quadrant (internal mammary): 17 vessels (13.9%)\u003c/p\u003e\n\u003cp\u003e- Lower-lateral quadrant: 28 vessels (22.2%)\u003c/p\u003e\n\u003cp\u003e- Lower-medial quadrant: 0 vessels\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of our study was to establish the usefulness of ICG for mapping the superficial lymphatic network of the breast. The results of our work, which shows lymphatic diffusion of ICG in 53 of the 60 injections performed, demonstrated the feasibility of identifying mammary lymphatic vessels using ICG injections.\u003c/p\u003e \u003cp\u003eWe assumed that the images obtained corresponded to the lymphatic network and not to the arteriovenous system because of previous anatomical studies showing that the latter does not overlap with the lymphatic network [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Thus, the mapping of the mammary arteriovenous system would be significantly different from the lymphatic system and would not produce superimposable images [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eICG is now a common tool for the exploration of the arteriovenous system [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Its use for lymphatic network exploration benefits from the cadaveric study of Shinaoka et al [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] who mapped the lymphatic network of the limbs after subcutaneous injection of the dye in the hands and feet. This anatomical study was then confirmed in vivo by the work of Unno et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, ICG has a low radiation intensity which limits its use for the detection of deep lymphatic vessels because infrared cameras cannot detect radiation deeper than 2 cm [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The results obtained in this work are therefore limited to the superficial lymphatic network. Subsequently, the use of ICG seems to be of less interest in obese subjects or in areas with a large amount of fat such as the breast. Therefore, it doesn\u0026rsquo;t have any use for the detection of deep lymph nodes when searching for the sentinel lymph node.\u003c/p\u003e \u003cp\u003eIn order to overcome these limitations, Yamashita et al suggest to apply a transparent material to the study area to enhance the detection of radiation by vitro pressure [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Schaafsma et al. suggest the combination of ICG and technetium to form a hybrid tracer providing greater spatial resolution [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe chose to include both male and female subjects in this study. Although anatomical studies of the male breast are rare in the literature, they show that the vascularity of the breast is similar between men and women [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In addition, axillary prosthetic breast augmentation surgery is equally applicable to women for cosmetic purposes as it is to men during sex reassignment surgery. The topographical analysis of the superficial lymphatic vessels revealed by the ICG injection shows that they are predominantly distributed in the superior-external quadrant, corresponding to the axillary zone. This analysis is consistent with previous anatomical studies of the mammary lymphatic network [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Previous anatomical studies describe two lymphatic networks in the breast: superficial and deep [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Our findings strongly suggest the predominance of the superficial lymphatic network of the breast, which seems to be the main contributor to lymphatic drainage to the axillary lymphnode, confirming Sappey\u0026rsquo;s findings. Sappey described a primary centripetal lymphatic drainage to the subareolar plexus via the deep network, then, secondarily, the lymph travels to the superficial network to reach the axillary lymph nodes [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe noticed during the experiments that the vessels belonging to the upper external quadrant run in the direction of the axillary fossa, without actually ever reaching it.\u003c/p\u003e \u003cp\u003eThis phenomenon confirms various studies [\u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] reporting an anatomical zone located behind the lateral edge of the pectoralis major, near the lower pole of the axillary fossa, where the lymph nodes responsible for breast drainage are concentrated: the \"Soft Tissue Triangle\" (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). This area is located at a distance from the axillary approach, which is used for prosthetic augmentation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs this is an original study of mammary lymphatic circulation in the cadaveric subject, there is no previous work regarding the optimal amount to be injected. We based our study on the results of Murawa et al [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] who showed that the level of fluorescence obtained was directly correlated to the dose injected. Therefore, as this was a cadaveric study, we chose to inject a whole dose of infracyanin, i.e. 25 mg of product, in order to potentiate the fluorescence capabilities of the ICG. This amount may need to be adjusted for in vivo lymph nodes detection.\u003c/p\u003e \u003cp\u003eThe study of lymphatic circulation in anatomical subjects suffers from an important limitation related to the absence of tissue perfusion pressure. In vivo, lymph flow through vessels is governed by both intrinsic factor, the spontaneous contractility of endothelial cells and extrinsic factors: muscle contraction, perfusion pressure, respiratory amplitude for thoracic lymph vessels [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. We based our protocol on various previous works using massage to enhance ICG diffusion in cadavers [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and described passive diffusion time after dye injection during which the diffusion of ICG within the lymphatic vessels was related solely to the mechanical pressure induced by the syringe. Massaging of the injection site was performed afterwards to theoretically reproduce the effect exerted by the cardiac pump under physiological conditions.\u003c/p\u003e \u003cp\u003eHowever, several limitations to this study should be noted. Amongst the 60 breast injections performed, only 53 were usable. There was some heterogeneity among the subjects. The sex ratio was unbalanced (10 men and 20 women), and the state of preservation was not identical amongst all subjects. The study included only 8 \"fresh\" subjects, i.e. deceased for less than 72 hours and never frozen.\u003c/p\u003e \u003cp\u003eThe 7 excluded breasts in which it was not possible to detect lymphatic vessels were characterized by the formation of a diffusion \"cloud\" at the dye injection site (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Two hypothesis can be proposed: a degradation of the mammary lymphatic network in the cadaver or a handling mistake during the injection leading to a deeper penetration of the dye not allowing its absorption by the subareolar plexus of the anatomical subjects.\u003c/p\u003e \u003cp\u003eInterestingly, one of the excluded breasts belonged to a subject in which a satisfactory result was obtained on the contralateral breast, inciting us not to neglect the possibility of a handling mistake.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe value of ICG for the study of skin perfusion is now well recognized and its use for the study of lymphatic vessels is in full development. Our work shows that ICG is an effective tracer for mapping the superficial lymphatic network of the breast and our results regarding lymphatic networks of the breast are consistent with those of the existing literature. Its intraoperative use in breast augmentation surgery would allow for better control of subcutaneous dissection and help preserve the integrity of the lymphatic network. However, the inherent limitations of any cadaveric study do not allow us to extrapolate these results to the living. An in vivo study will be required to confirm these results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors have no personal, Financial or institutional interest in any of the drugs, materials or devices describes in this article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the people who donated their bodies for making this study possible and for improving medical knowledge.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical Approval :\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003eCompeting interests\u0026nbsp;:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare that they have no ties of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors contributions\u0026nbsp;:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;1 : Y CLAUDIC : Data collection, writing and protocol development \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2\u0026nbsp;: A PERRUISSEAU-CARRIER\u0026nbsp;: Manuscrit editing\u003c/p\u003e\n\u003cp\u003e3\u0026nbsp;: Charlie DEMARTELEIRE : Manuscrit editing\u003c/p\u003e\n\u003cp\u003e4 : Weiguo HU : Manuscrit editing and protocol development \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5 : Romuald SEIZEUR : Manuscrit editing and protocol development \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding :\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe data are available upon request to the corresponding author\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSalmon RJ, Montemagno S, Laki F, Alran S, Charitansky H, Fourchotte V, et al. 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Annals of Plastic Surgery 2013;71:591\u0026ndash;4. https://doi.org/10.1097/SAP.0b013e318255168a.\u003c/li\u003e\n\u003cli\u003eGashev AA, Nagai T, Bridenbaugh EA. Indocyanine Green and Lymphatic Imaging: Current Problems. Lymphatic Research and Biology 2010;8:127\u0026ndash;30. https://doi.org/10.1089/lrb.2010.0005.\u003c/li\u003e\n\u003cli\u003eOgata F, Azuma R, Kikuchi M, Koshima I, Morimoto Y. Novel Lymphography Using Indocyanine Green Dye for Near-Infrared Fluorescence Labeling. Annals of Plastic Surgery 2007;58:652\u0026ndash;5. https://doi.org/10.1097/01.sap.0000250896.42800.a2.\u003c/li\u003e\n\u003cli\u003evan Deventer PV, Page BJ, Graewe FR. Vascular Anatomy of the Breast and Nipple-Areola Complex: Plastic and Reconstructive Surgery 2008;121:1860\u0026ndash;1. https://doi.org/10.1097/PRS.0b013e31816b14d5.\u003c/li\u003e\n\u003cli\u003eEllis H, Colborn GL, Skandalakis JE. Surgical Embryology and Anatomy of the Breast and its Related Anatomic Structures. Surgical Clinics of North America 1993;73:611\u0026ndash;32. https://doi.org/10.1016/S0039-6109(16)46077-9.\u003c/li\u003e\n\u003cli\u003eCunningham L. The anatomy of the arteries and veins of the breast. J Surg Oncol 1977;9:71\u0026ndash;85. https://doi.org/10.1002/jso.2930090112.\u003c/li\u003e\n\u003cli\u003eCorduff N, Rozen WM, Taylor GI. The superficial venous drainage of the breast: A clinical study and implications for breast reduction surgery. Journal of Plastic, Reconstructive \u0026amp; Aesthetic Surgery 2010;63:809\u0026ndash;13. https://doi.org/10.1016/j.bjps.2009.02.055.\u003c/li\u003e\n\u003cli\u003eAndres A-C, Djonov V. The Mammary Gland Vasculature Revisited. J Mammary Gland Biol Neoplasia 2010;15:319\u0026ndash;28. https://doi.org/10.1007/s10911-010-9186-9.\u003c/li\u003e\n\u003cli\u003eDing N, Yu N, Dong R, Kong L, Xue H, Long X, et al. Blood supply of the male breast nipple-areola complex evaluated by CTA. Journal of Plastic, Reconstructive \u0026amp; Aesthetic Surgery 2021;74:2588\u0026ndash;95. https://doi.org/10.1016/j.bjps.2021.02.006.\u003c/li\u003e\n\u003cli\u003eOrguc S, Basara I, Coskun T, Pekindil G. 3D vascular mapping of breast using contrast enhanced mri: association of unilateral increased vascularity with ipsilateral breast cancer. Diagn Interv Radiol 2012. https://doi.org/10.4261/1305-3825.DIR.5280-11.2.\u003c/li\u003e\n\u003cli\u003eBlondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. British Journal of Plastic Surgery 1999;52:104\u0026ndash;11. https://doi.org/10.1054/bjps.1998.3033.\u003c/li\u003e\n\u003cli\u003eMattison GL, Lewis PG, Gupta SC, Kim HY. SPY Imaging Use in Postmastectomy Breast Reconstruction Patients: Preventative or Overly Conservative? Plastic and Reconstructive Surgery 2016;138:15e\u0026ndash;21e. https://doi.org/10.1097/PRS.0000000000002266.\u003c/li\u003e\n\u003cli\u003eHolm C, Dornseifer U, Sturtz G, Ninkovic M. Sensitivity and Specificity of ICG Angiography in Free Flap Reexploration. J Reconstr Microsurg 2010;26:311\u0026ndash;6. https://doi.org/10.1055/s-0030-1249314.\u003c/li\u003e\n\u003cli\u003eShinaoka A, Koshimune S, Yamada K, Kumagishi K, Suami H, Kimata Y, et al. A Fresh Cadaver Study on Indocyanine Green Fluorescence Lymphography: A New Whole-Body Imaging Technique for Investigating the Superficial Lymphatics. Plastic and Reconstructive Surgery 2018;141:1161\u0026ndash;4. https://doi.org/10.1097/PRS.0000000000004315.\u003c/li\u003e\n\u003cli\u003eUnno N, Nishiyama M, Suzuki M, Yamamoto N, Inuzuka K, Sagara D, et al. Quantitative Lymph Imaging for Assessment of Lymph Function using Indocyanine Green Fluorescence Lymphography. European Journal of Vascular and Endovascular Surgery 2008;36:230\u0026ndash;6. https://doi.org/10.1016/j.ejvs.2008.04.013.\u003c/li\u003e\n\u003cli\u003eUnno N, Nishiyama M, Suzuki M, Tanaka H, Yamamoto N, Sagara D, et al. A novel method of measuring human lymphatic pumping using indocyanine green fluorescence lymphography. Journal of Vascular Surgery 2010;52:946\u0026ndash;52. https://doi.org/10.1016/j.jvs.2010.04.067.\u003c/li\u003e\n\u003cli\u003eYamashita M, Yamamoto T, Yamamoto N, Furuya M, Ishiura R, Hayashi A. Diascopic indocyanine green lymphography for deep lymphatic visualization. Journal of Plastic, Reconstructive \u0026amp; Aesthetic Surgery 2014;67:e293\u0026ndash;4. https://doi.org/10.1016/j.bjps.2014.07.029.\u003c/li\u003e\n\u003cli\u003eAndersen JA, Gram JB. MALE BREAST AT AUTOPSY. Acta Pathologica Microbiologica Scandinavica Series A :Pathology 2009;90A:191\u0026ndash;7. https://doi.org/10.1111/j.1699-0463.1982.tb00081_90A.x.\u003c/li\u003e\n\u003cli\u003eSappey C. Description et iconographie des vaisseaux lymphatiques, consid\u0026eacute;r\u0026eacute;s chez l\u0026rsquo;homme et les vert\u0026eacute;br\u0026eacute;s. Paris, Delahaye. 1885.\u003c/li\u003e\n\u003cli\u003eSappey MPC. Anatomie, physiologie, pathologie des vaisseaux lymphatiques consid\u0026eacute;r\u0026eacute;s chez l\u0026rsquo;homme et les vert\u0026eacute;br\u0026eacute;s. Adrien Delahaye. 1874.\u003c/li\u003e\n\u003cli\u003eMottura AA, Del Castillo R. Transaxillary Breast Augmentation: Two Breast Cancer Patients with Successful Sentinel Lymph Node Diagnosis. Aesth Plast Surg 2007;31:544\u0026ndash;9. https://doi.org/10.1007/s00266-006-0260-z.\u003c/li\u003e\n\u003cli\u003eHuang G. Sentinel lymph node biopsy in the augmented breast: Role of the transaxillary subpectoral approach. Aesthetic Surgery Journal 2003;23:184\u0026ndash;7. https://doi.org/10.1067/maj.2003.38.\u003c/li\u003e\n\u003cli\u003eGraf RM, Canan LW, Romano GG, Tolazzi ARD, Cruz GA de O e. Implications of Transaxillary Breast Augmentation: Lifetime Probability for the Development of Breast Cancer and Sentinel Node Mapping Interference. Aesth Plast Surg 2007;31:322\u0026ndash;4. https://doi.org/10.1007/s00266-006-0204-7.\u003c/li\u003e\n\u003cli\u003eSado HN, Graf RM, Canan LW, Romano GG, Timi JR, Matias JE, et al. Sentinel Lymph Node Detection and Evidence of Axillary Lymphatic Integrity After Transaxillary Breast Augmentation: A Prospective Study Using Lymphoscintography. Aesth Plast Surg 2008;32:879\u0026ndash;88. https://doi.org/10.1007/s00266-008-9212-0.\u003c/li\u003e\n\u003cli\u003eRiquet M. Physiologie de la circulation lymphatique 2019:12.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Indocyanine green, Breast anatomy, Breast lymphatic network, Anatomical study, Breast augmentation, Breast prosthesis","lastPublishedDoi":"10.21203/rs.3.rs-2251230/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2251230/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eIndocyanine 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe 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.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e","manuscriptTitle":"Mapping of the superficial lymphatic network of the breast using indocyanine green injection: an anatomical study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-14 15:07:16","doi":"10.21203/rs.3.rs-2251230/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fe0c0dd1-4173-42e6-ba66-ea5fe63560e1","owner":[],"postedDate":"November 14th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-12-08T16:14:25+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-14 15:07:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2251230","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2251230","identity":"rs-2251230","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}