Breast sensation after superior pedicle versus inferior pedicle mammaplasty: anatomical and histological evaluation.
Despite contradictory information about the course and distribution of the nerves supplying the breast, surgical techniques using an inferior pedicle have been recommended over those using a superior pedicle for preserving the nipple-areolar sensation after surgery. This anatomical study was designed to quantify the nerve branches preserved in inferior and superior pedicles after reduction mammaplasty performed on cadavers. Reduction mammaplasty was done on four fresh cadavers (within 48h of death) using a superior pedicle on the right and an inferior pedicle on the left in a standard way. The pedicle was cut at its base and then fixed in formalin. The base was divided in biopsy specimens and embedded in paraffin. The nerves were quantified and located in each pedicle with haematoxylin-eosin stain and light-microscopic evaluation. Histological evaluation of the pedicles showed the presence of a variable number of nerves (between one and seven) within two superior pedicles and three inferior pedicles. The nerves were located in fibrous tissue and accompanied by vessels in most cases. The nerves were always found superficially and were most likely to be located in the central part of the pedicle. Our results showed that including the nerves within the pedicle is technically uncertain regardless of the mammaplasty technique used. The final recovery of sensation in the breast after mammaplasty seems to result from the regeneration of severed cutaneous nerve branches or the remaining cutaneous innervation rather than the preserved adjacent cutaneous branches.
Hamdi
M
M
Department of Plastic Surgery, C. H. U. Brugmann Free University of Brussels, Belgium.
Greuse
M
M
Nemec
E
E
Deprez
C
C
De Mey
A
A
D001706:Biopsy; D001940:Breast / Q000294:innervation* / Q000473:pathology; D002102:Cadaver; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D017933:Peripheral Nervous System / Q000473:pathology; D011184:Postoperative Period; D012677:Sensation; D013524:Surgical Flaps