Dealing with the Displaced Nipple-Areola Complex in Macromastia Using a Superomedial Pedicle and Inverted T Pattern

Area of Science:

• Plastic Surgery
• Breast Surgery
• Surgical Anatomy

Background:

• Macromastia often presents with nipple-areola complex (NAC) displacement, particularly in patients with elevated Body Mass Index (BMI).
• The incidence and surgical management of displaced NAC in macromastia are under-documented in existing literature.
• Understanding the pathogenesis of NAC displacement is crucial for effective surgical planning.

Purpose of the Study:

• To determine the incidence of nipple-areola complex (NAC) displacement in macromastia patients.
• To evaluate the surgical management of displaced NAC using a superomedial pedicle with modified inverted-T/keyhole pattern.
• To propose a theory for the pathogenesis of NAC displacement in macromastia.

Main Methods:

• Retrospective review of patients undergoing breast reduction over a two-and-a-half-year period.
• Inclusion criteria: NAC displacement of 3 cm or more from the breast meridian.
• Surgical technique involved a superomedial pedicle with canted vertical limbs of the inverted T/keyhole pattern, adjusted for medial or lateral NAC deviation.

Main Results:

• Fifteen patients met inclusion criteria: 3 with medial and 12 with lateral NAC displacement.
• Mean patient age was 35 years, mean BMI 31, and mean excised tissue weight 1158g.
• Complications included partial areola loss in one patient and wound breakdown at the inverted T junction in two patients. Mean follow-up was 7 months.

Conclusions:

• Displaced nipple-areola complex (NAC) is a frequent finding in macromastia patients with elevated BMI.
• Modifying the inverted T/keyhole pattern by canting the vertical limbs away from the deviated NAC, using a superomedial pedicle, yields satisfactory outcomes.
• A theory of pathogenesis suggests global attenuation of the breast footplate leads to inferior and lateral NAC displacement.