Treatment of delayed venous congestion of the nipple-areolar complex after reduction mammoplasty

Abstract

Reduction mammoplasty is a popular operation worldwide. Early complications include bleeding, wound dehiscence, and nipple-areolar complex (NAC) ischemia. Although uncommon, NAC ischemia can lead to necrosis of the NAC. NAC congestion is usually recognized intraoperatively or within a few hours of the operation. A 21-yearold woman with severe macromastia received bilateral reduction mammoplasty using a Wise-pattern reduction with a superomedial pedicle. NAC congestion of the left breast was identified 40 hours after the operation. Delayed venous congestion of the NAC after reduction mammoplasty has not been previously reported; in this case, delayed congestion may have been caused by partial venous obstruction aggravated by the progression of tissue edema near the pedicle. Through use of the delayed suture technique, application of nitroglycerin cream, intravenous administration of prostaglandin E1, and use of a portable negative-pressure wound therapy device, the patient's NAC was salvaged with satisfactory nipple projection and minimal scarring.

The Use of Medicinal Leeching in Breast Surgery: A Systematic Review

“…In addition to the regular use of reconstructive techniques such as the pedicled flaps (e.g., pedicled trans rectus abdominis myocutaneous flap) and free flaps (e.g., deep inferior epigastric artery perforator flap), non-reconstructive breast surgery is also threatened by compromised venous supply. For example, in mammoplasty and mastopexy, moving the vascular pedicle supplying the nipple areolar complex (NAC) to its new position may compromise venous patency resulting in a congested NAC [ 5 ]. Therefore, in breast surgery, venous insufficiency can be caused either by thrombosis of the anastomosed pedicle, a compromise to the pedicle supplying the NAC, or by a more distal venous insufficiency at the level of the cutaneous venosome of the flap.…”