Blood Supply to the Nipple–Areola Complex and Intraoperative Imaging of Nipple Perfusion Patterns
Ischemic complications involving the nipple–areola complex (NAC) occur in 3–37% of cases of nipple-sparing mastectomies (NSM). Loss of the NAC to ischemic necrosis postoperatively is very distressing to patients who chose a NSM and expect to keep their nipple. Understanding the anatomy of the blood supply to the NAC and ensuring that the preserved skin envelope provides adequate blood supply to the NAC in NSM is key to decreasing ischemic complications. In this chapter, we review the blood supply to the breast and to the NAC, the implications for pedicled flap design, and methods of intraoperative imaging of breast perfusion, including fluorescein angiography, infrared imaging, Doppler sonography, tissue spectrophotometry, and near-infrared spectroscopy. This chapter specifically focuses on indocyanine green angiography, which has rapidly become part of nipple-sparing mastectomy operating room equipment.
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