title: Importance of the suprasternal notch to nipple distance (SSN:N) for vascular complications of the nipple areola complex (NAC) in the superior pedicle vertical mammaplasty: a retrospective analysis.
abstract: BACKGROUND
  The superior pedicle, frequently used with vertical mammaplasty, bears some risk for vascular complications of the nipple areola complex (NAC) particularly in large breasts. The suprasternal notch to nipple distance (SSN:N), geometrically associated with the longitudinal axis of the breast and length of the superior pedicle, might be an indicative parameter to assess these complications. Importance of the SSN:N for vascular complication of the NAC was focussed upon in this study.
  
  
  METHODS
  Arterial and venous complications of 104 patients following the superior pedicle vertical mammaplasty were retrospectively evaluated both sided (n=208 breasts), according to the preoperatively measured SSN:N. Binary logistic regression (p≤0.05) was used for statistical evaluation.
  
  
  RESULTS
  Probability of vascular compromise of the NAC is influenced by the SSN:N within the context of the superior pedicle vertical mammaplasty. An SSN:N>30 cm (n=112 breasts) is subject to venous (p=0.002) as well as arterial (p=0.232) complications of the NAC, both of which may result in partial necrosis of the tissue (p=0.029).
  
  
  CONCLUSIONS
  The SSN:N measurement can be helpful to identify patients at risk for vascular complications of the superiorly stalked NAC. Modifications of the superior pedicle or other pedicles potentially providing enhanced vascular impact might be considered with an SSN:N beyond 30 cm to reduce vasculature-related complications of the NAC.
authors.affiliation: Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, RWTH Aachen University, Pauwelsstr. 30, D-52074 Aachen, Germany. dodey@ukaachen.de
authors.forename: Dan Mon
authors.initials: DM
authors.lastname: O'Dey
authors.forename: Peter
authors.initials: P
authors.lastname: Baltes
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bozkurt
authors.forename: Norbert
authors.initials: N
authors.lastname: Pallua
mesh_terms: D000328:Adult; D001837:Body Weights and Measures; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D009336:Necrosis; D009558:Nipples / Q000098:blood supply* / Q000473:pathology; D012189:Retrospective Studies; D013249:Sternum; D013524:Surgical Flaps / Q000098:blood supply* / Q000473:pathology