Skin circulation in the nipple after reduction mammaplasty by upper and lower glandular resections

Avascular necrosis of the nipple is a serious complication of reduction mammaplasty with nipple transposition. A study was undertaken to measure the skin circulation in the nipple before, during and after this operation. In 14 patients undergoing a reduction mammaplasty according to the method of Strömbeck, the skin circulation was measured in 25 breasts with laser doppler flowmetry (LDF) and fluorescein flowmetry (FF). LDF showed that the skin circulation increased after de-epithelialization to 204.4 +/- 31.0% of the preoperative value (100%) (mean +/- SEM, p less than 0.01). After the upper and lower glandular resection the circulation was reduced to 90.7 +/- 12.3% of the preoperative value. The division of the lateral pedicle did not affect the circulation. After the skin had been sutured, the circulation was 71.5 +/- 9.1% of the preoperative value (p less than 0.01). One to four days postoperatively the circulation was 100.3 +/- 13.2% of the preoperative value. At FF uniform fluorescence was observed in the nipple postoperatively in all patients but two, in whom avascular necrosis later developed. Our results thus show that the circulation in the nipple after reduction mammaplasty by the Strömbeck method is adequate and that it is safe to divide the lateral dermal pedicle.