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Nipple-Sparing Gigantomastia Breast Reduction: A Systematic Review
Ian Zelko1, Anthony DeLeonibus, Jalal Haidar
1From the Cleveland Clinic, Dermatology and Plastic Surgery Institute, Cleveland, OH.
Annals of Plastic Surgery
|February 16, 2023
Summary
Nipple-sparing breast reduction is safe for large, ptotic breasts, challenging historical assumptions about nipple necrosis. This review analyzed complication rates to assess safety in gigantomastia procedures.
Area of Science:
- Plastic Surgery
- Breast Surgery
- Gigantomastia Management
Background:
- Gigantomastia lacks a clear definition, leading to varied surgical approaches and outdated patient education.
- Historical surgical dogma suggested free nipple grafts were necessary for large breast reductions to prevent nipple necrosis, a notion this review questions.
Approach:
- A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted.
- PubMed database searches were performed in October 2021, with study screening facilitated by Rayyan Intelligent Systematic Review software.
Key Points:
- Twenty-two articles comprising 1689 patients were analyzed, with a mean BMI of 32.9.
- The mean resection weight was 1423.8g per breast, with Wise pattern incisions and inferior/superomedial pedicles being most common.
- Nipple-areolar complex necrosis rates were 1.7% (complete) and 5.9% (partial); other complications included delayed wound healing (17.4%) and surgical site infection (14.3%).
Conclusions:
- Nipple-sparing breast reduction is a safe and viable option for patients with hypertrophic and severely ptotic breasts.
- The incidence of nipple-areolar complex complications, including necrosis, is lower than previously assumed in these challenging cases.
