Preserving the neurovascular supply in the Hall-Findlay superomedial pedicle breast reduction: an anatomical study.
BACKGROUND
The Hall-Findlay superomedial pedicle technique is widely used for breast reduction, and, despite low complication rates, nipple-areola complex (NAC) necrosis and denervation are still the two most common complications, particularly when resection volumes exceed 600g. An understanding of the anatomy of the neurovascular pedicle of the NAC is paramount in avoiding these complications.


METHODS
An anatomical study was undertaken on 11 female cadaveric breast specimens (nine fresh and two embalmed). The neurovascular anatomy of the breast was explored through dissection, microdissection, radiographic, computed tomographic, photographic and cross-sectional studies. The superomedial pedicle was mapped out on each specimen, and the course of the relevant nerves and vasculature was identified.


RESULTS
The arterial supply to the superomedial pedicle was found to originate from a single dominant vessel in each specimen, while the venous drainage was via an extensive branching network. Both vascular patterns traversed the pedicle in a superficial plane. The innervation of the pedicle was via intercostal branches, which coursed extremely superficially in the pedicle.


CONCLUSIONS
De-epithelialisation or superficial thinning of the superomedial pedicle for breast reduction is at high risk for complications related to vascular compromise or denervation. Where greater resection is needed, this should be done from the deep surface or the base of the pedicle, contrary to previous descriptions.
Michelle le Roux
Cara
C
Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Room E533, Department of Anatomy and Cell Biology, The University of Melbourne, Grattan St, Parkville, VIC 3050, Australia. michelleleroux@live.com.au
Kiil
Birgitte J
BJ
Pan
Wei-Ren
WR
Rozen
Warren M
WM
Ashton
Mark W
MW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000033:anatomy & histology* / Q000601:surgery; D002102:Cadaver; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000033:anatomy & histology*; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000033:anatomy & histology*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation*; D014057:Tomography, X-Ray Computed