title: Bilateral accessory breast tissue of the vulva: a case report introducing a novel labiaplasty technique.
abstract: BACKGROUND
  We present the case of a 23-year-old female with bilateral ectopic breast tissue of the vulva, the repair of which necessitated a novel labiaplasty technique. Labiaplasty is becoming an increasingly frequent cosmetic procedure, and the popularity of brief didactic labiaplasty courses has risen in response to consumer demand. There is a paucity of detailed anatomic description of female sensory innervation patterns to the clitoris and surrounding structures. This places patients at risk for denervation of clitoral structures during labiaplasty procedures. Our novel technique proposes a method of individualized patient neurosensory mapping preoperatively, which allows for surgical planning to avoid injury to the sensory branches of the dorsal clitoral nerve.
  
  
  METHODS
  A 23-year-old female presented with bilateral vulvar masses that involved the clitoral complex, which had first become apparent during the second trimester of pregnancy, and failed to resolve in the postpartum period. We describe the preoperative planning and intraoperative approach and dissection to labiaplasty in this patient, which was complex given the size of the masses, and specifically designed to avoid injury to sensory branches of the dorsal clitoral nerve.
  
  
  CONCLUSIONS
  As labiaplasty becomes more common, it is important to approach labiaplasty patients with a detailed understanding of the sensory innervation of the clitoris and surrounding structures, to avoid nerve injury and resultant sexual dysfunction. Traditional labiaplasty approaches may violate the sensory innervation patterns of the clitoral region, thus causing a sensory loss that affects patient sexual function. Our novel approach to preoperative clitoral nerve sensory mapping provides an alternative method of labiaplasty that may avoid denervation injury.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA. iwagner@unch.unc.edu
authors.forename: I Janelle
authors.initials: IJ
authors.lastname: Wagner
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Damitz
authors.forename: Erin
authors.initials: E
authors.lastname: Carey
authors.forename: Denniz
authors.initials: D
authors.lastname: Zolnoun
mesh_terms: D001940:Breast; D002828:Choristoma / Q000601:surgery*; D005260:Female; D006801:Humans; D059348:Peripheral Nerve Injuries / Q000517:prevention & control*; D060525:Pudendal Nerve / Q000293:injuries*; D014844:Vulva / Q000294:innervation / Q000601:surgery*; D014845:Vulvar Diseases / Q000601:surgery*; D055815:Young Adult
references.citation: Obstet Gynecol. 2011 Aug;118(2 Pt 2):478-480
references.pmid: 21768859
references.citation: Vojnosanit Pregl. 2008 May;65(5):407-9
references.pmid: 18630137
references.citation: Aust N Z J Obstet Gynaecol. 2004 Apr;44(2):166-7
references.pmid: 15089845
references.citation: Aust N Z J Obstet Gynaecol. 2007 Oct;47(5):424-5
references.pmid: 17877604
references.citation: J Pediatr Adolesc Gynecol. 2009 Aug;22(4):e41-4
references.pmid: 19493516
references.citation: Ann R Coll Surg Engl. 2011 Oct;93(7):e147-8
references.pmid: 22004627
references.citation: J Obstet Gynaecol. 2007 Jul;27(5):530-1
references.pmid: 17701814
references.citation: Arch Gynecol Obstet. 2009 Aug;280(2):317-20
references.pmid: 19125265