Main Article Content
mammaplasty, nipples, necrosis, hypertrophy, computed x-ray tomography
Introduction: This study aimed to investigate the dominant vascular supply to the nipple areolar complex (NAC) using CTA and whether the preoperative CTA could change surgical planning and reduce the incidence of nipple necrosis after breast reductions for patients considered to be at a high risk of nipple loss.
Methods: All female CT thoraces performed at a single centre between January and May 2013 were reviewed by a single cardiothoracic radiologist to find arterial sources, which intercostal space that was perforated, glandular/subcutaneous course and vessel entry point into the NAC of each breast. Preoperative planning CTA’s performed for the 28 cases of high-risk breast reductions of the 392 breast reductions between 2008 and 2014.
Results: Analysis was performed on CTAs of 69 patient cases, involving 132 breasts. The dominant blood supply was the internal mammary artery (IMA) in 96 breasts, with long thoracic artery (LTA) in 21 breasts. A dominant vascular supply was identified in all cases. In 27 of the 28 cases, preoperative planning was undertaken as guided by the CTA. Of the 28 cases, there was one case of unilateral infection, one hematoma, and a single case of partial thickness areolar necrosis. No free nipple grafts were required.
Conclusion: Preoperative CTA for large-volume breast reduction may be a useful surgical planning tool for high-risk patients. With CTA, pedicle design can be tailored to the specific patient’s blood supply in order to reduce the incidence of necrosis and avoid the need for free nipple grafts.
2. Schnur PL, Schnur DP, Petty PM, Hanson TJ, Weaver AL. Reduction mammaplasty: an outcome study. Plast Reconstr Surg. 1997; 100(4): 875–83. https://doi.org/10.1097/00006534-199709001-00008 PMid:9290655
3. Cunningham BL, Gear AJL, Kerrigan CL, Collins DE. Analysis of breast reduction complications derived from the BRAVO study. Plast Reconstr Surg. 2005; 115(6): 1597–604. https://doi.org/10.1097/01.PRS.0000160695.33457.DB PMid:15861063
4. O’Dey D BP, Bozkurt A, Pallua N. Importance of suprasternal notch to nipple distance for vascular complications of the nipple areola complex in the superior pedicle vertical mammaplasty: a retrospective analysis. J Plast Reconstr Aesthet Surg. 2011; 64: 1278e–283. https://doi.org/10.1016/j.bjps.2011.05.012
5. Lewin R, Goransson M, Elander A, Thorarinsson A, Lundberg J, Lidén M. Risk factors for complications after breast reduction surgery. J Plast Surg Hand Surg. 2014; 48(1): 10–14. https://doi.org/10.3109/2000656X.2013.791625 PMid:23627557
6. Hawtof DB, Levine M, Kapetansky DI, Pieper D. Complications of reduction mammaplasty: comparison of nipple-areolar graft and pedicle. Ann Plast Surg. 1989; 23: 3. https://doi.org/10.1097/00000637-198907000-00002 PMid:2764458
7. Seitz IA, Nixon AT, Friedewald SM, Rimler JC, Schechter LS. NACsomes: a new classification system of the blood supply to the nipple areola complex (NAC) based on diagnostic breast MRI exams. J Plast Reconstr Aesthet Surg. 2015; 68(6): 792–99. https://doi.org/10.1016/j.bjps.2015.02.027
8. Hamdi M, Greuse M, De Mey A, Webster MH. A prospective quantitative comparison of breast sensation after superior and inferior pedicle mammoplasty. Brit J Plast Surg. 2001; 54(1): 39–42. https://doi.org/10.1054/bjps.2000.3456
9. Zubowski R, Zins JE, Foray-Kaplon A et al Relationship of obesity and specimen weight to complications in reduction mammaplasty. Plast Reconstr Surg. 2000; 106: 998. https://doi.org/10.1097/00006534-200010000-00006 PMid:11039370
10. Cunningham L. The anatomy of the arteries and veins of the breast. J Surg Oncol. 1977; 9(1): 71e–85. Nakajima H, Imanishi N, Aiso S. Arterial anatomy of the nipple- areola complex. Plast Reconstr Surg. 1995; 96: 843e–45. https://doi.org/10.1002/jso.2930090112
11. O’Dey D, Prescher A, Pallua N. Vascular reliability of nipple-areola complex-bearing pedicles: an anatomical microdissection study. Plast Reconstr Surg. 2007; 119: 1167e–177. https://doi.org/10.1097/01.prs.0000254360.98241.dc
12. Nakajima H, Imanishi N, Aiso S. Arterial anatomy of the nipple- areola complex. Plast Reconstr Surg. 1995;96:843e5. https://doi.org/10.1097/00006534-199509001-00012
13. Van Deventer P. The blood supply to the nipple-areola complex of the human mammary gland. Aesthet Plast Surg. 2004; 28: 393e–98. https://doi.org/10.1007/s00266-003-7113-9
14. Stirling AD, Murray CP, Lee MA. The arterial supply to the nipple areola complex (NAC) and its relations: an analysis of the angiographic CT imaging for breast pedicle design. Surg Radiol Anat. 2017; 39: 1127–134.