Preventing Venous Congestion of the Nipple-Areola Complex: An Anatomical Guide to Preserving Essential Venous Drainage Networks

Roux, Cara Michelle le; Pan, Wei‐Ren; Matousek, Simone A.; Ashton, Mark W.

doi:10.1097/prs.0b013e3182044bb2

Cited by 33 publications

(21 citation statements)

References 20 publications

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“…After formation of the periareolar plexus, the cutaneous perforators travel within the subcutaneous tissue before reaching the NAC and after mastectomy the NAC relies solely on these cutaneous branches as the underlying breast tissue has been removed [1, 26]. With respect to vascular outflow, the NAC is drained through a superior and inferior horizontal venous sling (Figure 4) [27]. After mastectomy, the NAC drainage relies heavily on the superficial, inferiorly coursing venous network [27].…”

Section: Discussionmentioning

confidence: 99%

“…With respect to vascular outflow, the NAC is drained through a superior and inferior horizontal venous sling (Figure 4) [27]. After mastectomy, the NAC drainage relies heavily on the superficial, inferiorly coursing venous network [27]. The cutaneous venous system is even more superficial than the arterial network and as such is more likely to be damaged during deepithelialization [27].…”

Section: Discussionmentioning

confidence: 99%

“…After mastectomy, the NAC drainage relies heavily on the superficial, inferiorly coursing venous network [27]. The cutaneous venous system is even more superficial than the arterial network and as such is more likely to be damaged during deepithelialization [27]. Necrosis of the NAC results from either arterial or venous insufficiency and the latter appears to be even more prevalent with larger breast resection volumes [13, 27–29].…”

Section: Discussionmentioning

confidence: 99%

“…The cutaneous venous system is even more superficial than the arterial network and as such is more likely to be damaged during deepithelialization [27]. Necrosis of the NAC results from either arterial or venous insufficiency and the latter appears to be even more prevalent with larger breast resection volumes [13, 27–29]. Given the vascular anatomy of the NAC, expanding the base of the pedicle in a lateral fashion should theoretically preserve more of the arterial supply and venous drainage.…”

Section: Discussionmentioning

confidence: 99%

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Single Stage Nipple-Sparing Mastectomy and Reduction Mastopexy in the Ptotic Breast

Pontell

Saad

Brown

et al. 2018

Plastic Surgery International

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Purpose Given the proposed increased risk of nipple-areolar complex (NAC) necrosis, nipple-sparing mastectomy (NSM) is generally not recommended for patients with large or significantly ptotic breasts. NAC preserving strategies in this subgroup include staged or simultaneous NSM and reduction mastopexy. We present a novel approach towards simultaneous NSM and reduction mastopexy in patients with large, ptotic breasts. Methods Literature pertaining to NSM for women with large, ptotic breasts was reviewed and a surgical approach was designed to allow for simultaneous NSM and reduction mastopexy in such patients. Results Eight patients underwent bilateral NSM with simultaneous reduction mammaplasty and immediate reconstruction. The majority of breasts demonstrated advanced ptosis (69% grade III, 31% grade II) and the average breast volume excised was 760 grams. In those patients without a history of smoking, NAC necrosis rates were 0%. In those patients with a history of smoking, 83% of breasts experienced NAC necrosis (60% total, 40% partial). One hundred percent of patients who smoked experienced some degree of NAC necrosis. Among breasts with grade II versus grade III ptosis, NAC necrosis rates were roughly equal. Conclusions Historically, patients with large, ptotic breasts were excluded from NSM due to the proposed increased risk of NAC necrosis. This study demonstrates a safe approach towards NSM and reduction mastopexy using an inferior, wide-based, epithelialized pedicle. While all patients eventually achieved satisfactory results, there was an association between smoking and NAC necrosis. Smoking cessation is paramount to the operation's success.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Single Stage Nipple-Sparing Mastectomy and Reduction Mastopexy in the Ptotic Breast

Pontell

Saad

Brown

et al. 2018

Plastic Surgery International

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“…10 A 2cm incision was made at the contralateralmost extent of the flap, extending only to the subdermal plexus. One to three subdermal veins were cannu lated and perfused with normal saline then ink as above.…”

Section: Venous Studiesmentioning

confidence: 99%

The Microvascular Basis of the Superior Thyroid Artery Perforator Flap

Ross

Wilson

Ashton

2015

Plastic and Reconstructive Surgery

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Intercostal nerve block of the anterior cutaneous branches and the sensibility of the female breast

et al. 2019

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Introduction Better sensation in the reconstructed breast improves the quality of life. Sensory nerve coaptation is a valuable addition to autologous breast reconstruction. There are few publications concerning the sensory nerves of the breast and the nipple‐areola complex and reports are contradictory, so it is unknown which nerve is best suited as a recipient for coaptation. The current study serves as a proof of concept. Materials and Methods The areas innervated by the anterior cutaneous branches (ACBs) of the intercostal nerves (ICNs) were studied on two separate occasions in two healthy women. First, the ACBs of ICNs 2–5 were individually blocked using ultrasound. Next, the ACBs of all levels were blocked simultaneously. Sensation was measured using Semmes‐Weinstein monofilaments. The numbed areas corresponding to the ICNs were drawn in a raster of 2 × 2 cm. Results The largest area was supplied by the ACB of the 4th ICN, located in the upper (UIQ) and the lower (LIQ) inner quadrants of the breast. The 2nd‐largest area was supplied by the ACB of the 3rd ICN. Blockage of ACBs 2–5 affected sensation in the nipple and the areola. Conclusions Blockage of all levels 2–5 partially affected sensation in the nipple‐areola complex, suggesting innervation by a nerve plexus consisting of both ACBs and lateral cutaneous branches (LCBs). ACB4 supplied the largest area of the breast in the UIQ and LIQ and could be best suited for sensory nerve coaptation to optimize sensation in the autologously reconstructed breast.

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Preventing Venous Congestion of the Nipple-Areola Complex: An Anatomical Guide to Preserving Essential Venous Drainage Networks

Abstract: The breast contains an extensive venous network. To avoid necrosis of the nipple-areola complex, this venous network should be preserved. The superomedial/medial and inferior pedicles contain the most extensive and more reliable venous drainage patterns.

Cited by 33 publications

References 20 publications

Single Stage Nipple-Sparing Mastectomy and Reduction Mastopexy in the Ptotic Breast

Single Stage Nipple-Sparing Mastectomy and Reduction Mastopexy in the Ptotic Breast

The Microvascular Basis of the Superior Thyroid Artery Perforator Flap

Intercostal nerve block of the anterior cutaneous branches and the sensibility of the female breast

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