| Popis: |
**Introduction**: Large volume breasts, and also breasts with a long distance between the sternal notch and the nipple, have a higher risk of postoperative nipple necrosis after breast reduction surgery. This is due to vascular insufficiency. For these high-risk cases, free nipple grafts are sometimes performed. Free nipple grafts are not an ideal technique due to reduced sensation, duct disruption, variable take and common result of an under-projecting nipple and poor aesthetic outcome. In order to avoid both necrosis of the nipples and the use of free nipple grafts, we have investigated the use of angiographic computerized tomography (CTA) in the selection of the dominant blood supply in breast reduction pedicle selection. The first aim of this study was to investigate the dominant vascular supply to the nipple areolar complex (NAC) using CTA. The second aim was to investigate whether the preoperative CTA could change surgical planning and also reduce the incidence of nipple necrosis after breast reductions for patients considered to be at a high risk of nipple loss. **Methods**: Phase 1: All female CT thoraces performed at a single centre between January and May 2013 were reviewed by a single cardiothoracic radiologist to find arterial sources, which intercostal space that was perforated, glandular/subcutaneous course and vessel entry point into the NAC of each breast. Phase 2: Preoperative planning CTA’s performed for the 28 cases of high-risk breast reductions of the 392 breast reductions between 2008 and 2014. **Results**: Phase 1: The analysis was performed on CTAs of 69 patient cases, involving 132 breasts. The dominant blood supply was the internal mammary artery (IMA) in 96 breasts, with long thoracic artery (LTA) in 21 breasts. Phase 2: A dominant vascular supply was identified in all cases. In 27 of the 28 cases, preoperative planning was undertaken as guided by the CTA. Of the 28 cases, there was one case of unilateral infection, one hematoma, and a single case of partial thickness areolar necrosis. No free nipple grafts were required. **Conclusion**: Preoperative CTA for large-volume breast reduction may be a useful surgical planning tool for high-risk patients. With the insight gleaned from a CTA, pedicle design can be tailored to the specific patient’s blood supply in order to reduce the incidence of necrosis to the nipple areolar complex and to avoid the need for free nipple grafts. |
