P. Brownlee1, D. Chesire1, M. Crandall1, J. Murray1 1University Of Florida,Jacksonville, FL, USA
Introduction: Nipple-areola complex (NAC) necrosis is a dreaded complication of reduction mammaplasty that results from tissue ischemia. Multiple breast reduction techniques have been designed, each with the goal of minimizing complications and optimizing aesthetic outcomes. The superomedial pedicle (SMP) reduction mammaplasty offers several advantages over more traditional operative techniques, such as improved preservation of long-term breast shape. However, many surgeons believe that using the superior and superomedial pedicles cause an increase in NAC necrosis rates up to 7.0-10.0% as the degree of macromastia increases. The aim of this paper is to show that the superomedial pedicle has comparable NAC necrosis rates to other breast reduction techniques and can be used in any size reduction without a significant risk to the NAC.
Methods: We performed a retrospective study of patients who underwent breast reduction surgery by a single surgeon between May 1, 2013 and May 1, 2015. We reviewed patient demographics, operative details, the weight of the breast tissue removed per pathology report, and post-operative findings up to six months after the date of their operation. Patients were excluded from this study if they were converted to free nipple grafting intra-operatively prior to completion of their initial operation (n=3). Each breast was counted as an individual data point and then divided into subgroups based on the weight of the tissue removed. Using SPSS version 23 and chi-square analysis, the subgroups were compared against each other to look for a significant difference in rates of NAC necrosis. The overall rate of NAC necrosis in this study was also determined and compared to those of previously reported rates for alternative pedicle techniques.
Results: 70 patients (130 breasts) met inclusion criteria for this study. The average age at time of reduction was 38 years old, and the patients had a mean body mass index (BMI) of 36.6 kg/m2. The mean resection weight per breast was 1016.7 grams (± 478.3). The mean pre-operative sternal notch to nipple distance was 36.3 cm (± 5.3). The overall NAC necrosis rate was 0.7%, with 0% in the groups where less than 1200 grams of tissue were removed and 2.3% in the group where 1200 grams or more of tissue were removed. There was no significant difference with respect to the number of patients developing NAC necrosis across these groups.
Conclusion: The superomedial pedicle breast reduction has an overall rate of NAC necrosis which compares favorably to other more popular techniques, and this study shows no significant increase in NAC necrosis with larger volume tissue reductions. Given the benefits of this technique when compared to alternative pedicles, such as preservation of breast shape and nipple sensitivity, it should be considered a safe choice for any size breast reduction.