The arterial supply of the nipple areola complex (NAC) and its relations: an analysis of angiographic CT imaging for breast pedicle design

Stirling, Aaron; Murray, Conor; Lee, Mark A.

doi:10.1007/s00276-017-1858-3

Cited by 17 publications

(11 citation statements)

References 23 publications

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“…In contrast to the acceptable overall complication rate compared with skin-sparing mastectomy or modified radical mastectomy, skin (including NAC) necrosis was significantly higher in NSM based on a meta-analysis study using the Cochrane database [ 15 ]. During the surgery, glandular and ductal tissues are maximally resected to reduce the possibility of locoregional recurrence [ 16 ], which can injure the blood supply of the breast skin and the NAC [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction

et al. 2020

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Background Nipple-sparing mastectomy (NSM), followed by immediate reconstruction (IR) of the breast, has become a preferred surgical procedure with good cosmesis results and patient satisfaction. However, nipple-areolar complex (NAC) ischemia and necrosis remain major problems after NSM and IR. Methods We retrospectively analyzed patients who underwent NSM and IR at Gangnam Severance Hospital from January 2009 to June 2018. We compared the patient characteristics and complication rate among three different incisions (inframammary fold [IMF], radial, periareolar). Additionally, we identified the risk factors of NAC necrosis. Results Data from 290 eligible breasts in 275 patients were analyzed. Patients with IMF incision had relatively lower breast weights. The overall complication rate was the highest with periareolar incision and the lowest with IMF incision (42.6% vs. 18.8%, p < 0.001). The rate of NAC ischemia or necrosis was significantly different among the three incisions (9.7%, 17.0%, and 31.1% in IMF, radial, and periareolar, respectively; p < 0.001). Moreover, surgical treatments were more frequently needed in patients with periareolar incision. Periareolar incision, short distance from the tumor to the nipple base, and large breast weight were independent risk factors of NAC ischemia or necrosis in multivariable analysis. Conclusions Compared with IMF incision, periareolar incision was associated with higher incidences of surgical complications and NAC necrosis. Careful consideration is needed when planning NSM in patients with a large breast volume or a tumor close to the nipple.

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Section: Introductionmentioning

confidence: 99%

Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction

et al. 2020

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“…This is the same or less than the average annual background radiation exposure and equates to 2mSv. 14 Therefore we consider the possibility of avoiding nipple necrosis in higher-risk breast AJOPS | ORIGINAL ARTICLE Kierath, Lewin, Lee: Preoperative CT angiography to facilitate pedicle selection for high risk breast reduction patients reductions outweighs the problems associated to the limited exposure of radiation during the CTA.…”

Section: Discussionmentioning

confidence: 99%

“…5,[9][10][11][12][13] Previous studies of the dominant vascular pedicle have been limited to a small number of cadaver dissections [10][11][12] and, more recently, MRI analysis. 13 The aim of the present study was firstly to investigate the vascular supply to the NAC using angiographic computerised tomography (CTA) 14 and secondly to investigate if the preoperative CTA could change the surgical planning to reduce the incidence of nipple necrosis after breast reductions in patients considered to be in at a high risk of nipple loss.…”

Section: Introductionmentioning

confidence: 99%

Preoperative CT angiography to facilitate pedicle selection for high-risk breast reduction patients

Kierath

Lewin

Lee

2018

Australas J Plast Surg

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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.

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“…Reliable NAC flaps are based on anatomically‐defined arterial and venous territories. The arterial network of the breast has been described in several detailed anatomic studies The description of the breast septum, which includes the arteries and nerves of the NAC, is the most important contribution to the breast anatomy …”

Section: Introductionmentioning

confidence: 99%

“…1 Reliable NAC flaps are based on anatomically-defined arterial and venous territories. The arterial network of the breast has been described in several detailed anatomic studies [2][3][4] The description of the breast septum, which includes the arteries and nerves of the NAC, is the most important contribution to the breast anatomy. 3 The aim of this article is to report the author' experience with the medial-central septum based mammaplasty for breast reshaping after massive weight loss, evaluating whether the technique described could be reliable to obtain the reduction in the volume of the breast, to preserve blood supply and innervation to the nipple-areola complex, to lift the nipple-areola complex to a higher position on the breast mound, to create an aesthetic shape that is stable over time.…”

Section: Introductionmentioning

confidence: 99%

The medial‐central septum based mammaplasty: A reliable technique to preserve nipple‐areola complex sensitivity in post bariatric patients

et al. 2019

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Introduction Massive weight loss is associated with the ptosis of the breast, loss of the upper pole fullness, medialization of the nipples and volume depletion. Post bariatric patients often need breast reshaping with mastopexy or breast reduction. We report the author's experience with the medial central septum based mammoplasty for breast reshaping after massive weight loss. Methods We retrospectively reviewed the records of 85 women who underwent a medial‐central septum based mammaplasty, analyzing patients (age, BMI, comorbidities) and operation specific characteristics’ (surgical technique, complications) to identify the advantages and the drawbacks of the adopted technique. All the procedures were performed at a single institution by the senior author of this article. Results 85 patients were included in the review, in total 170 medial‐central septum based mammaplasty were performed over a five years period. Early complications, as hematoma and seroma occurred in 2 patients. No total or partial nipple‐areola losses were recorded and the viability of the nipple‐areola complex (NAC) was excellent in all the treated patients. Sensation was retained in all breasts. Nine patients showed delayed wound healing at the joint of the T scar; in 5 patients we observed spreading scars. Conclusion The medial‐central septum based mammaplasty seems to be an effective and safe choice for breast reshaping after massive weight loss, as none of our patients experienced nipple loss and all of them reported good nipple sensation. Moreover, the technique is versatile and can be applied to patients with hypertrophic breasts or gigantomastia.

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The arterial supply of the nipple areola complex (NAC) and its relations: an analysis of angiographic CT imaging for breast pedicle design

Cited by 17 publications

References 23 publications

Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction

Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction

Preoperative CT angiography to facilitate pedicle selection for high-risk breast reduction patients

The medial‐central septum based mammaplasty: A reliable technique to preserve nipple‐areola complex sensitivity in post bariatric patients

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