[Anatomic considerations to improve vasculature of the nipple-areola complex in vertical mammaplasty].
OBJECTIVE
This anatomic study is intended to point out the most regular and reproducible vessels supplying the nipple-areola complex (NAC) for use in vertical mammaplasty.


BACKGROUND
The superior pedicle technique routinely performed within the context of vertical mammaplasty procedures bears some risk for vascular dependent complications of the NAC especially in large breasts. Concerning vasculature, the supposedly most eligible pedicle to use should meet equally the best vascular requirements and technical demands necessary for maintaining both viability of the NAC and plasticity of the entire breast tissue.


METHODS
Based on an anatomic microdissection study of the thoracic vessel system of seven female corpses, a modification of the superior pedicle approach to carry the NAC was anatomically evaluated and tailored to vertical mammaplasty performed in the L-technique.


RESULTS
Out of six vascular sources responsible for the blood supply to the breast the branches originating from the lateral thoracic artery and concomitant veins appeared to reflect the major source of blood supply to the NAC due to their regularity and reproducibility. Especially the full-thickness glandular-dermal superolaterally-based pedicle should safely enclose these dominant branches, as well as supplementary vessels deriving from minor important sources in this region, while keeping plasticity of the vertically reduced breast.


CONCLUSIONS
The superolaterally-based full-thickness glandular-dermal pedicle mobilized epipectorally to carry the NAC proves to be anatomically a safe and reliable procedure eligible as an integral part of vertical mammaplasty.
O'Dey
D M
DM
Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinik RWTH Aachen. D.m.ODey@t-online.de
Prescher
A
A
Pallua
N
N
D001940:Breast / Q000098:blood supply; D005260:Female; D006801:Humans; D007511:Ischemia / Q000473:pathology / Q000517:prevention & control; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D009558:Nipples / Q000098:blood supply*; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control; D013524:Surgical Flaps / Q000098:blood supply; D013895:Thoracic Arteries / Q000473:pathology / Q000601:surgery; D014680:Veins / Q000473:pathology / Q000601:surgery