Skip to main content

Advertisement

SpringerLink
Log in

Preserving the Nipple Projection in Breast Reduction with the Free Nipple-Areolar Graft Technique: Purse-String Suture

  • Original Article
  • Breast Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Breast reduction with the free nipple-areolar graft (FNG) technique has disadvantages such as loss of nipple projection, loss of nipple sensation, and depigmentation of the nipple-areolar complex. In this study, patients in whom a purse-string (PS) suture was used in the center of the de-epithelialized area to prevent loss of nipple projection were compared with patients who underwent the conventional method.

Methods

A retrospective analysis of the patients who underwent breast reduction with the FNG was conducted in our department. Patients were divided into two groups according to the FNG placement. In the PS suture method group, a 1-cm-diameter circumferential suture was placed with a 5-0 Monocryl® (poliglecaprone 25) suture to gain a 6-mm-nipple projection. In the conventional method group, the FNG was placed directly over the de-epithelized area. Graft viability was evaluated after 3 weeks postoperatively. The final nipple projection and depigmentation were evaluated after 6 months postoperatively. The results were evaluated with statistical tests.

Results

The number of patients with the conventional method was 10, and the PS suture method was 12. There was no statistically significant difference between two groups regarding graft loss and depigmentation (p > 0.05). Nipple projection was significantly higher in the PS method group (p < 0.05).

Conclusion

We observed that PS circumferential suture made an acceptable nipple projection compared to the conventional method in breast reduction with the FNG technique. Since the method is easy to apply and has relatively low risk, it would contribute to clinical practice.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lessard L, Papanastasiou C, Fortin M et al (2023) Breast hypertrophy: a real pain in the back. Plast Reconstr Surg 151:498–508

    Article  CAS  PubMed  Google Scholar 

  2. Crittenden TA, Watson DI, Ratcliffe J et al (2023) Long-term outcomes of breast reduction surgery: a prospective cohort study. J Plast Reconstr Aesthet Surg 79:58–67

    Article  PubMed  Google Scholar 

  3. Lo AY, Yu RP, Raghuram A et al (2020) Patient characteristics associated with free nipple graft reduction mammoplasty. Cureus 12:e9063

    PubMed  PubMed Central  Google Scholar 

  4. Colen SR (2001) Breast reduction with use of the free nipple graft technique. Aesthet Surg J 21:261–271

    Article  CAS  PubMed  Google Scholar 

  5. Firat C, Gurlek A, Erbatur S et al (2012) An autoprosthesis technique for better breast projection in free nipple graft reduction mammaplasty. Aesthet Plast Surg 36:1340–1346

    Article  Google Scholar 

  6. Sterodimas A, Pineda EF, Meirelles V et al (2008) Maximizing nipple graft survival after performing free nipple-areolar complex reduction mammaplasty. J Plast Reconstr Aesthet Surg 61:971–972

    Article  PubMed  Google Scholar 

  7. Engel R, Greenberg Y, Siddiqui A (2022) Negative pressure wound therapy for improved nipple survival in large volume reduction mammaplasty. Aesthet Plast Surg 46:108–112

    Article  Google Scholar 

  8. Abramson DL (1999) Increasing projection in patients undergoing free nipple graft reduction mammoplasty. Aesthet Plast Surg 23:282–284

    Article  CAS  Google Scholar 

  9. Thorek M (1989) Possibilities in the reconstruction of the human form 1922. Aesthet Plast Surg 13:55–58

    Article  CAS  Google Scholar 

  10. McGregor JC, Hafeez A (2006) Is there still a place for free nipple areolar grafting in breast reduction surgery? A review of cases over a three year period. J Plast Reconstr Aesthet Surg 59(3):213–218

    Article  PubMed  Google Scholar 

  11. Basaran K, Basat SO, Mercan ES et al (2015) The use of dermabrasion to achieve natural-looking areolas following breast reduction or mastopexy: a study of 23 patients. Aesthet Plast Surg 39:534–539

    Article  Google Scholar 

  12. Karabagli Y, Kose AA, Mangir S et al (2012) e-Flap nipple reconstruction in amputation mammaplasty. Aesthet Plast Surg 36:1140–1143

    Article  Google Scholar 

  13. Bektas G, Cinpolat A, Bicici P et al (2012) A new application to free-nipple-graft reduction mammaplasty for breast and nipple projection. Eplasty 12:339–341

    Google Scholar 

  14. Casas LA, Byun MY, Depoli PA (2001) Maximizing breast projection after free-nipple-graft reduction mammaplasty. Plast Reconstr Surg 107:955–960

    Article  CAS  PubMed  Google Scholar 

  15. Bitik O, Uzun H, Zins JE (2013) Nipple areola reconstructing reduction mammaplasty. Aesthet Surg J 33:1129–1137

    Article  PubMed  Google Scholar 

  16. Lee HJ, Ock JJ (2019) How to improve projection in nipple reconstruction: a modified method using acellular dermal matrix disk and fragments. Plast Reconstr Surg 143:698e–706e

    Article  CAS  PubMed  Google Scholar 

  17. Fujisawa D, Asato H, Suzuki Y et al (2018) Quadruped and dermal bridge flap for nipple reconstruction. Plast Reconstr Surg Glob Open 6:e1872

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sisti A, Grimaldi L, Tassinari J et al (2016) Nipple-areola complex reconstruction techniques: a literature review. Eur J Surg Oncol 42:441–465

    Article  CAS  PubMed  Google Scholar 

  19. Sue GR, Seither JG, Nguyen DH (2020) Use of hyaluronic acid filler for enhancement of nipple projection following breast reconstruction: an easy and effective technique. JPRAS Open 23:19–25

    Article  PubMed  Google Scholar 

  20. Yukun L, Ke G, Jiaming S (2016) Application of nipple retractor for correction of nipple inversion: a 10-year experience. Aesthet Plast Surg 40:707–715

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara City Hospital, Yildirim Beyazit University, Universiteler Mah. 1604. Cad. No: 9, Cankaya, 06800, Ankara, Turkey

    Mehmet Sonmez

  2. Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara City Hospital, University of Health Sciences, Universiteler Mah. 1604. Cad. No: 9, Cankaya, 06800, Ankara, Turkey

    Murat Enes Saglam

Authors
  1. Mehmet Sonmez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Murat Enes Saglam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Sonmez.

Ethics declarations

Conflict of interest

There is no conflict of interests to disclose.

Ethical Approval

The study was performed after approval by the Ethics Committee of Ankara City Hospital (E.Board-E1-23-3330).

Informed Consent

Informed consent was obtained from all patients in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MPG 1572 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sonmez, M., Saglam, M.E. Preserving the Nipple Projection in Breast Reduction with the Free Nipple-Areolar Graft Technique: Purse-String Suture. Aesth Plast Surg 47, 2255–2260 (2023). https://doi.org/10.1007/s00266-023-03429-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-023-03429-5

Keywords

Search

Navigation