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Nipple-Areolar Complex Ischemia: Management During Aesthetic Mammoplasties

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Nipple-Areolar Complex Reconstruction

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Abstract

Partial or total nipple necrosis after aesthetic mammoplasty surgery can occur. Continuous nipple-areolar complex (NAC) checking and early identification of vascular compromise, followed by appropriate action, may help prevent total NAC loss. The authors describe the vascular anatomy of the breast, associated risk factors, preoperative information, vitality of the NAC during closure, NAC ischemia, intraoperative NAC perfusion evaluation, intraoperative NAC reperfusion and maneuvers, free NAC graft indications, when should a NAC free graft be considered, complications of free nipple grafting, postoperative care, wound care for NAC necrosis, protocol for sequelae treatment, can we predict NAC viability, and ICG intraoperative procedure.

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References

  1. Grotting JC, Neligan PC. Plastic surgery. In: Breast, vol. 5. 3rd ed. Philadelphia: Elsevier; 2012. p. 247.

    Google Scholar 

  2. Manahan MA, Buretta KJ, Chang D, Mithani SK, Mallalieu J, Shermak MA. An outcomes analysis of 2142 breast reduction procedures. Ann Plast Surg. 2015;74(3):289–92.

    Article  PubMed  CAS  Google Scholar 

  3. Stolier AJ, Levine EA. Reducing the risk of nipple necrosis: technical observations in 340 nipple-sparing mastectomies. Breast J. 2013;19:173–9.

    Article  PubMed  Google Scholar 

  4. Hofmann AK, Wuestner-Hofmann MC, Bassetto F, Scarpa C, Mazzoleni F. Breast reduction: modified “Lejour technique” in 500 large breasts. Plast Reconstr Surg. 2007;120:1095–104.

    Article  PubMed  CAS  Google Scholar 

  5. Spear SL, Rottman SJ, Seiboth LA, Hannan CM. Breast reconstruction using a staged nipple-sparing mastectomy following mastopexy or reduction. Plast Reconstr Surg. 2012;129:572–81.

    Article  PubMed  CAS  Google Scholar 

  6. van Deventer PV, Page BJ, Graewe FR. The safety of pedicles in breast reduction and mastopexy procedures. Aesthet Plast Surg. 2008;32:307–12.

    Article  Google Scholar 

  7. Woods JE, Meland NB. Conservative management in full-thickness nipple-areolar necrosis after subcutaneous mastectomy. Plast Reconstr Surg. 1989;84:258–64.

    Article  PubMed  CAS  Google Scholar 

  8. Mojallal A, Comparin JP, Voulliaume D, Chichery A, Papalia I, Foyatier JL. Reduction mammaplasty using superior pedicle in macromastia. Ann Chir Plast Esthet. 2005;50(2):118–26.

    Article  PubMed  CAS  Google Scholar 

  9. Lugo LM, Prada M, Kohanzadeh S, Mesa JM, Long JN, de la Torre J. Surgical outcomes of gigantomastia breast reduction superomedial pedicle technique: a 12-year retrospective study. Ann Plast Surg. 2013;70(5):533–7.

    Article  PubMed  CAS  Google Scholar 

  10. Landau AG, Hudson DA. Choosing the superomedial pedicle for reduction mammaplasty in gigantomastia. Plast Reconstr Surg. 2008;121:735–9.

    Article  PubMed  CAS  Google Scholar 

  11. Hester TR Jr, Bostwick J 3rd, Miller L, Cunningham SJ. Breast reduction utilizing the maximally vascularized central breast pedicle. Plast Reconstr Surg. 1985;76:890–900.

    Article  PubMed  Google Scholar 

  12. Wray RC, Luce EA. Treatment of impending nipple necrosis following reduction mammaplasty. Plast Reconstr Surg. 1981;68:242–4.

    Article  PubMed  CAS  Google Scholar 

  13. Masia J, Larranaga J, Clavero JA, Vives L, Pons G, Pons JM. The value of the multidetector row computed tomography for the preoperative planning of deep inferior epigastric artery perforator flap: our experience in 162 cases. Ann Plast Surg. 2008;60:29–36.

    Article  PubMed  CAS  Google Scholar 

  14. Roth AC, Zook EG, Brown R, Zamboni WA. Nipple-areolar perfusion and reduction mammaplasty: correlation of laser Doppler readings with surgical complications. Plast Reconstr Surg. 1996;97:381–6.

    Article  CAS  PubMed  Google Scholar 

  15. Cunningham L. The anatomy of the arteries and veins of the breast. J Surg Oncol. 1977;9(1):71–85.

    Article  CAS  PubMed  Google Scholar 

  16. Findlay EH. Ischemia of the nipple, areola, and skin flaps. In: Fisher J, Handel N, editors. Problems in breast surgery: a repair manual. Boca Raton, FL: CRC Press; 2014. p. 493–5.

    Google Scholar 

  17. Wueringer E, Tschabitscher M. New aspects of the topographical anatomy of the mammary gland regarding its neurovascular supply along a regular ligamentous suspension. Eur J Morphol. 2002;40:181–9.

    Article  PubMed  Google Scholar 

  18. Hallock GG, Cusenz BJ. Salvage of the congested nipple during reduction mammoplasty. Aesthet Plast Surg. 1986;10:143–5.

    Article  CAS  Google Scholar 

  19. Seamon MJ, Wobb J, Gaughan JP, Kulp H, Kamel I, Dempsey DT. The effects of intraoperative hypothermia on surgical site infection: an analysis of 524 trauma laparotomies. Ann Surg. 2012;255(4):789–95.

    Article  PubMed  Google Scholar 

  20. O’Dey DM, Prescher A, Pallua N. Vascular reliability of nipple-areola complex-bearing pedicles: an anatomical microdissection study. Plast Reconstr Surg. 2006;118:292–3.

    Article  CAS  Google Scholar 

  21. Nahabedian MY, Mofid MM. Viability and sensation of the nipple-areolar complex after reduction mammaplasty. Ann Plast Surg. 2002;49:24–31.

    Article  PubMed  Google Scholar 

  22. Hammond DC, O’Connor EA, Knoll GM. The short-scar periareolar inferior pedicle reduction technique in severe mammary hypertrophy. Plast Reconstr Surg. 2015;135:34–40.

    Article  PubMed  CAS  Google Scholar 

  23. Lypka M, Rizvi M, Lapuerta L. The Graf/Biggs flap to increase upper pole projection in breast reductions with free nipple grafts. Aesthet Plast Surg. 2010;34:687–90.

    Article  Google Scholar 

  24. Steed DL. Debridement. Am J Surg. 2004;187(5A):71S–4S.

    Article  PubMed  Google Scholar 

  25. Wang P, Nuveen EJ. Diagnosis and management of areolar ischemia. Am J Cosmet Surg. 2012;29(2):159–70.

    Article  Google Scholar 

  26. Ramundo J, Gray M. Collagenase for enzymatic debridement: a systematic review. J Wound Ostomy Continence Nurs. 2009;36(6 Suppl):S4–11.

    Article  PubMed  Google Scholar 

  27. Knig M, Vanscheidt W, Augustin M, Kapp H. Enzymatic versus autolytic debridement of chronic leg ulcers: a prospective randomised trial. J Wound Care. 2005;14:320–3.

    Article  Google Scholar 

  28. Colakoglu S, Khansa I, Curtis MS, Yueh JH, Ogunleye A, Haewyon C, Tobias AM, Lee BT. Impact of complications on patient satisfaction in breast reconstruction. Plast Reconstr Surg. 2011;127(4):1428–36.

    Article  PubMed  CAS  Google Scholar 

  29. Hallock GG. Salvage by tattooing of areolar complications following breast reduction. Plast Reconstr Surg. 1993;91:942–5.

    Article  PubMed  CAS  Google Scholar 

  30. Nahai FR, Nahai F. Breast reduction. Plast Reconstr Surg. 2008;121(1 Suppl):1–13.

    Article  PubMed  Google Scholar 

  31. Wuringer E, Mader N, Posch E, Holle J. Nerve and vessel sup plying ligamentous suspension of the mammary gland. Plast Reconstr Surg. 1998;101:1486–93.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Oncoplastic Surgery, Instituto Oncologico Henry Moore, University of Buenos Aires, Buenos Aires, Argentina

    Alberto Rancati M.D., Ph.D.

  2. Department of Plastic Surgery, Hospital Santojanni, Buenos Aires, Argentina

    Claudio Angrigiani M.D.

  3. Department of Oculoplastic Surgery, Instituto Oncologico Henry Moore, University of Buenos Aires, Buenos Aires, Argentina

    Marcelo Irigo M.D., Ph.D.

  4. Instituto Oncologico Henry Moore, University of Buenos Aires, Buenos Aires, Argentina

    Braulio Peralta M.D.

Authors
  1. Alberto Rancati M.D., Ph.D.
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  2. Claudio Angrigiani M.D.
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  3. Marcelo Irigo M.D., Ph.D.
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  4. Braulio Peralta M.D.
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Corresponding author

Correspondence to Alberto Rancati M.D., Ph.D. .

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Editors and Affiliations

  1. Private Practice, Tustin, California, USA

    Melvin A. Shiffman

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Rancati, A., Angrigiani, C., Irigo, M., Peralta, B. (2018). Nipple-Areolar Complex Ischemia: Management During Aesthetic Mammoplasties. In: Shiffman, M. (eds) Nipple-Areolar Complex Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-60925-6_29

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  • DOI: https://doi.org/10.1007/978-3-319-60925-6_29

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60924-9

  • Online ISBN: 978-3-319-60925-6

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