Patient Characteristics Associated with Free Nipple Graft Reduction Mammoplasty

Abstract

Purpose: Surgical approaches for reduction mammoplasty most commonly incorporate a parenchymal vascular pedicle. For patients with larger breasts where pedicle viability may be compromised due to excessive length, the free nipple graft (FNG) technique provides a safe alternative. Criteria for whether a patient should undergo a FNG remains controversial due to variable reports in the literature with small sample sizes and inherent surgeon-dependent bias. To address this, we sought to investigate perioperative factors associated with performing FNGs at our institution in order to better elucidate specific indications for this surgery. Methods: A retrospective chart review was performed for 323 patients who underwent a reduction mammoplasty from August 2009 to July 2019 at Keck Hospital and LAC+USC Medical Center. Data regarding patient demographics, comorbidities, pre-operative breast characteristics, and post-operative complications were extracted. Studentʼs t-test, Fisherʼs exact test, and logistic regression were performed in R. Results: Of 323 patients, 15 received an FNG. Independent variables analyzed included: age, body mass index (BMI), obesity, smoking, diabetes, hypertension, surgical indication, sternal notch-to-nipple length, nipple-to-inframammary fold length, and weight of breast specimens removed. BMI, obesity, gigantomastia, and weight of specimen resected were significantly associated with use of the FNG (p < 0.001, p < 0.05, p < 0.0001, p < 0.0001, respectively). Regression analysis revealed that patients who had an average of more than 1500 g of tissue removed from each breast were 1.41 (95% CI: 1.17-1.71, p<0.001) times more likely to undergo an FNG procedure than those who had less than 1500 g of tissue removed. Demographic data and breast characteristics, such as notch-to-nipple length and nipple-to-inframammary fold length, were not significantly associated. Conclusion: Total weight of the breast specimens removed and BMI were significantly associated with the FNG technique. Removing more than 1500 g gof total breast tissue was also significantly correlated. These findings may guide surgeons during the decision-making process of when to use an FNG.

Combined Superior and Inferior Dermoglandular Flaps for Projection Enhancement in Gigantic Breast Amputation and Free Nipple Areola Graft

“…For each item, a score ranged from 1-4 according to the patient satisfac-tion. The scores were summated from each questionnaire and graded as excellent (17)(18)(19)(20), good (14-16), fair (10-13), and poor result (5)(6)(7)(8)(9) as shown in Table (1).…”

“…Many techniques were described for correction of gigantomastia [4,5,6]. Reduction amputation mammaplasty with free nipple-areola grafting is reserved for patients complaining of gigantomastia and severe ptosis (the distance between the nipple and the inframammary fold exceeds 25cm [7,8].…”

Free Nipple Graft Breast Reduction without a Vertical Incision

“…However, these measures are not always effective in alleviating the symptoms and improving patient satisfaction. 2 When medical management fails, surgical options such as reduction mammoplasty (surgical resection of the breast parenchyma) are considered. 3…”

“…However, these measures are not always effective in alleviating the symptoms and improving patient satisfaction. 2 When medical management fails, surgical options such as reduction mammoplasty (surgical resection of the breast parenchyma) are considered. 3 Reduction mammoplasty involves an anchor or vertical pattern incision with either a superiorly or inferiorly based parenchymal vascular pedicle.…”

Inferior pedicle with inverted-T procedure for bilateral reduction mammoplasty provided satisfactory surgical and aesthetic outcome

“…5 Free nipple grafting as well as a variety of pedicled techniques were advocated for large reductions in obese patients, but the number of different approaches suggests that no single method is ideal. [6][7][8][9] The current study targets to present a series of women with macromastia who underwent bilateral reduction mammoplasty (RM) through the inferior pedicle with inverted-T (wise pattern reduction) approach and to evaluate the surgical and aesthetic outcomes and women' satisfaction 3-months postoperative (PO).…”