A New Pedicle for Patients with Macromastia and Grade III Ptosis Undergoing Nipple-Sparing Mastectomy

The incidence of nipple-areolar complex (NAC) necrosis is high in patients with macromastia and grade III ptosis having a nipple-sparing mastectomy (NSM). The pedicle selected is based on empirical cadaver studies. However, recent studies using digital subtraction magnetic resonance studies (DCE-MRI) and dopplers show that the major supply comes from superomedial (second intercostal perforator) and superolateral (lateral thoracic perforator). This study reports on the outcome of 55 patients having a NSM, where the superomedial and superior pedicles werecombined, over a 2 1/2-year period.

A retrospective study was undertaken. All patients had bilateral procedures using a Wise keyhole pattern.

Fifty five consecutive patients (96 breasts) were assessed. Average age is 42 years(range 23-61). Fifty patients had bilateral NSM (and autologous reconstruction), but in nine patients, the nipple was removed unilaterally due to cancer, leaving 91 breasts for assessment. Another three patients had unilateral prophylactic NSM and contralateral total mastectomy, and two patients had unilateral NSM with prosthetic reconstruction and contralateral breast reduction. 31 Patients had a BMI of ≥30 Total unilateral NAC necrosis occurred in two breasts. Unilateral areola necrosis (major>50%) occurred in four breasts, i.e. major necrosis rate of 6.2%. Minor unilateral areolar necrosis (<50%) occurred in three breasts, and NAC epidermolysis occurred in nine breasts, i.e. minor NAC necrosis rate of 12.5%.

NSM can be safely performed in patients with macromastia and grade III ptosis using the combined pedicle. High-risk patients may suffer limited areolar necrosis or epidermolysis.

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