title: Preventing venous congestion of the nipple-areola complex: an anatomical guide to preserving essential venous drainage networks.
abstract: BACKGROUND
  Venous congestion leading to partial or total nipple necrosis is a relatively uncommon complication of breast reduction and mastopexy procedures but still occurs, particularly in larger reduction procedures. This is largely preventable if the surgeon has an understanding of the venous drainage to the nipple and carefully preserves it.
  
  
  METHODS
  An anatomical study was undertaken on 16 fresh female cadaveric breast specimens. The venous drainage of the breast was explored through vascular injection, radiographic, and cross-sectional studies.
  
  
  RESULTS
  The venous drainage of the breast consists of an extensive network of vessels. The nipple-areola complex is drained by a superficial subareolar ring of veins that drains by means of medial and lateral veins. Laterally, superolateral and inferolateral veins drain into the subclavian veins, whereas medially, two veins drain into the internal mammary veins. An inferior vein drains the inferior quadrant of the breast in the midmammary line. Medially, the veins have a superficial course, whereas laterally, the veins follow a deeper course.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Parkville, Victoria, Australia From the Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne.
authors.forename: Cara Michelle
authors.initials: CM
authors.lastname: le Roux
authors.forename: Wei-Ren
authors.initials: WR
authors.lastname: Pan
authors.forename: Simone A
authors.initials: SA
authors.lastname: Matousek
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ashton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000150:complications / Q000517:prevention & control*; D008408:Mastectomy / Q000009:adverse effects; D009336:Necrosis / Q000209:etiology / Q000517:prevention & control; D009558:Nipples / Q000098:blood supply* / Q000601:surgery; D014680:Veins / Q000601:surgery*