Healing of Bilateral Nipple Areolar Complex Necrosis by Secondary Intention

Vazquez, Oscar A; Becker, Hilton

doi:10.7759/cureus.9025

Cited by 4 publications

(6 citation statements)

References 18 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The incidence rate of this was reported as 2.1% for complete nipple areolar complex necrosis and 7.3% for partial nipple areolar complex necrosis after a breast reduction using the superior pedicle and a vertical scar. [ 17 ] In our series, we did not observe circulation problems on the nipples during clinical observation, but we sought to determine whether there was a change in microvascular circulation that was not reflected at the clinic but which may be important in revision surgeries.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of nipple vascularity using superb microvascular imaging in patients with reduction mammoplasty

Gun Koplay,

Uysal

2023

Medicine

View full text Add to dashboard Cite

We aimed to investigate the effect of the chosen pedicle on nipple vascularity by evaluating changes in the microvascular circulation of the nipples in patients undergoing reduction mammoplasty through superb microvascular imaging study (SMI). 70 nipples were included in this retrospective study. There were 15 patients (30 nipples) in Group A using the inferior pedicle and 20 patients (40 nipples) in Group B using the superomedial pedicle. The vascular index (VI) of each nipple were evaluated preoperatively and at the third postoperative month using SMI. The mean VI in Group A was 1.25 (0.5–3.6) preoperatively and 1.3 (0.4–3.2) at the third postoperative month (P > .05). The mean VI in Group B was 1.65 (0.7/2.9) preoperatively and 1.15 (0.2/1.9) at the third postoperative month (P < .05). While the VI increased by 11.3% in Group A, it decreased by 30.6% in Group B (P < .001). The changing of the VI was analyzed between comparable groups, and decreasing microvascular circulation of the nipple with use of the superomedial pedicle was detected by quantitative values, which can be useful in at-risk patient groups, the planning of surgical procedures, and early revisions at postoperative month 3.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of nipple vascularity using superb microvascular imaging in patients with reduction mammoplasty

Gun Koplay,

Uysal

2023

Medicine

View full text Add to dashboard Cite

show abstract

“…The NAC is primarily supplied by perforators of the internal mammary artery with lesser contributions from the lateral mammary branches of the lateral thoracic artery and inferior mammary branches of the anterior intercostal arteries. 1 , 13 The nipple is most reliably drained by the superomedial/medial and inferior pedicles via superficial veins that course directly underneath the dermis. 2 As a result of its superficiality, the NAC’s venous network is more likely to be disrupted during breast surgery, resulting in problems with outflow more often than inflow.…”

Section: Discussionmentioning

confidence: 99%

Topical Dimethyl Sulfoxide for Congested Nipple–areolar Complexes in Breast Surgery: A Pilot Study

Silverstein

McLean

Crowley

et al. 2022

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: Necrosis of the nipple-areolar complex (NAC) is a major complication of breast surgery that most commonly results from venous congestion. Several conservative rescue therapies have been proposed for relieving NAC congestion, but each carries certain drawbacks, including cost and side effect profile. In this study, we evaluated the effectiveness of topical dimethyl sulfoxide (DMSO), an inexpensive compound with vasodilatory, free radical scavenging, and antiinflammatory properties in rescuing congested NACs. Methods: We conducted a review of all 15 patients treated with DMSO for NAC congestion at our institution between May 2019 and October 2020. DMSO was applied in liquid form on a soaked gauze pad in the hospital; patients were instructed to apply a DMSO cream to the NAC twice a day following discharge. Patient characteristics and data related to DMSO treatment and NAC healing were compared via univariate analysis. Results: Eighteen congested NACs from 15 patients who underwent mastectomy, breast reduction, mastopexy, or breast reconstruction were treated with DMSO. Of the 18 treated NACs, 15 healed with DMSO treatment alone. The average length of DMSO treatment was 9.4 ± 8.5 days (mean ± standard deviation); NAC healing took place over 9.9 ± 9.6 days. There were no complications related to DMSO treatment. Conclusions: This pilot study shows that DMSO may be an effective topical treatment for NAC congestion following breast surgery. Given its low cost, ease of application, and lack of side effects, future studies should prospectively compare DMSO against other topical treatments, like nitroglycerin ointment.

show abstract

“…Application of nitroglycerin ointment or intravenous administration of prostaglandin can promote venous drainage through vasodilation [5,16]. If all methods fail and partial or complete necrosis of the NAC is inevitable, healing by secondary intention may also be used with satisfactory outcomes depending on the patient [17].…”

Section: Discussionmentioning

confidence: 99%

Treatment of delayed venous congestion of the nipple-areolar complex after reduction mammoplasty

Park

Myung

2021

Arch Aesthetic Plast Surg

View full text Add to dashboard Cite

Reduction mammoplasty is a popular operation worldwide. Early complications include bleeding, wound dehiscence, and nipple-areolar complex (NAC) ischemia. Although uncommon, NAC ischemia can lead to necrosis of the NAC. NAC congestion is usually recognized intraoperatively or within a few hours of the operation. A 21-yearold woman with severe macromastia received bilateral reduction mammoplasty using a Wise-pattern reduction with a superomedial pedicle. NAC congestion of the left breast was identified 40 hours after the operation. Delayed venous congestion of the NAC after reduction mammoplasty has not been previously reported; in this case, delayed congestion may have been caused by partial venous obstruction aggravated by the progression of tissue edema near the pedicle. Through use of the delayed suture technique, application of nitroglycerin cream, intravenous administration of prostaglandin E1, and use of a portable negative-pressure wound therapy device, the patient's NAC was salvaged with satisfactory nipple projection and minimal scarring.

show abstract

Healing of Bilateral Nipple Areolar Complex Necrosis by Secondary Intention

Cited by 4 publications

References 18 publications

Evaluation of nipple vascularity using superb microvascular imaging in patients with reduction mammoplasty

Evaluation of nipple vascularity using superb microvascular imaging in patients with reduction mammoplasty

Topical Dimethyl Sulfoxide for Congested Nipple–areolar Complexes in Breast Surgery: A Pilot Study

Treatment of delayed venous congestion of the nipple-areolar complex after reduction mammoplasty

Contact Info

Product

Resources

About