Skin circulation in the nipple after reduction mammaplasty with a bipedicle vertical dermal flap

Necrosis of the nipple after a reduction mammaplasty with transposition of the nipple is a serious complication. A study was undertaken to measure the skin circulation in the nipple before, during and after this operation. In 16 patients undergoing reduction mammaplasty according to the method of McKissock, the skin circulation was measured in both breasts by laser Doppler flowmetry (LDF) and fluorescein flowmetry (FF). LDF showed that the skin circulation increased after de-epithelialization to 245.7 +/- 39.3% of the preoperative blood flow (100%) (mean +/- SEM, p less than 0.01). When 40 ml of 0.25% adrenaline was injected into the incision lines, the corresponding increase in blood flow was 153.4 +/- 15.6% (p less than 0.01). After the medical and lateral glandular resections the blood flow in the nipple of the vertical dermal pedicle was 125.6 +/- 21.2% of the preoperative blood flow and when adrenaline was given the corresponding value was 79.3 +/- 6.5%. After the skin had been sutured, the blood flow was 128.4 +/- 25.9% of the preoperative value and in the breast in which adrenaline was injected it was 177 +/- 96.9%. One to four days postoperatively the blood flow was 123.1 +/- 19.9% of the preoperative value and in the breast that received adrenaline 130 +/- 24%. At FF homogeneous fluorescence was observed in the nipple postoperatively in all patients but one; in this patient avascular necrosis later developed. Our results thus show that the circulation in the nipple after reduction mammaplasty by the McKissock method is adequate.