In Vivo Changes of Breast Perfusion After Augmentation.
BACKGROUND
Revision surgeries after breast augmentation are associated with an increased risk of complications (eg, nipple areolar complex [NAC]) necrosis. Consequently, maintaining perfusion to the NAC is a critical aspect of secondary breast surgery.


OBJECTIVE
The purpose of this study was to examine in vivo changes in perfusion to the NAC after implant breast augmentation using magnetic resonance imaging (MRI) technology.


METHODS
High-resolution 3 Tesla MRI images of 10 women (20 breasts) with previous breast augmentation were compared to a control population of 15 women (30 breasts). Perforators from the internal mammary artery and lateral thoracic artery were examined for the diameter of the originating perforator, distance between the nipple and most distally visualized point of the medial and lateral perforator, and dominance pattern between the medial vs lateral perforators.


RESULTS
No difference was found in the caliber of the medial vessels in the implant group compared to the control group. In contrast, the caliber of the lateral blood vessels trended towards being 20% larger in diameter in the augmented breasts. The distances between the nipple and the medial and lateral vessels increased. The frequencies in the distribution of dominance were not significantly different between the implant group and the control group.


CONCLUSIONS
Overall, medial and lateral blood supply to the NAC are preserved in the augmented patient. Our results suggest a slight delay effect that seems to increase the caliber of the lateral perforators. In addition, the tissue expansion provided by the implants effectively increases the length of both perforators.


METHODS
3 Therapeutic.
Dr Teng is an Attending, Cosmetic and Plastic Surgery, Carolinas Medical Center, Charlotte, NC. Dr Broer is an Attending and Dr Heidekrueger is a Resident, Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM - Klinikum Bogenhausen Academic Teaching Hospital, Technical University, Munich, Germany. Dr Forte is an Attending, Department of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL. Dr Lentz is a Resident, Division of Plastic and Reconstructive Surgery, UCSF Medical Center, San Francisco, CA. Dr Durand is a Resident and Dr Raghu is an Attending, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT. Dr Kwei is an Attending, Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT.
Edward
E
Teng
Dr Teng is an Attending, Cosmetic and Plastic Surgery, Carolinas Medical Center, Charlotte, NC. Dr Broer is an Attending and Dr Heidekrueger is a Resident, Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM - Klinikum Bogenhausen Academic Teaching Hospital, Technical University, Munich, Germany. Dr Forte is an Attending, Department of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL. Dr Lentz is a Resident, Division of Plastic and Reconstructive Surgery, UCSF Medical Center, San Francisco, CA. Dr Durand is a Resident and Dr Raghu is an Attending, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT. Dr Kwei is an Attending, Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT.
P Niclas
PN
Broer
Dr Teng is an Attending, Cosmetic and Plastic Surgery, Carolinas Medical Center, Charlotte, NC. Dr Broer is an Attending and Dr Heidekrueger is a Resident, Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM - Klinikum Bogenhausen Academic Teaching Hospital, Technical University, Munich, Germany. Dr Forte is an Attending, Department of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL. Dr Lentz is a Resident, Division of Plastic and Reconstructive Surgery, UCSF Medical Center, San Francisco, CA. Dr Durand is a Resident and Dr Raghu is an Attending, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT. Dr Kwei is an Attending, Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT.
Paul I
PI
Heidekrueger
Dr Teng is an Attending, Cosmetic and Plastic Surgery, Carolinas Medical Center, Charlotte, NC. Dr Broer is an Attending and Dr Heidekrueger is a Resident, Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM - Klinikum Bogenhausen Academic Teaching Hospital, Technical University, Munich, Germany. Dr Forte is an Attending, Department of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL. Dr Lentz is a Resident, Division of Plastic and Reconstructive Surgery, UCSF Medical Center, San Francisco, CA. Dr Durand is a Resident and Dr Raghu is an Attending, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT. Dr Kwei is an Attending, Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT.
Antonio J
AJ
Forte
Dr Teng is an Attending, Cosmetic and Plastic Surgery, Carolinas Medical Center, Charlotte, NC. Dr Broer is an Attending and Dr Heidekrueger is a Resident, Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM - Klinikum Bogenhausen Academic Teaching Hospital, Technical University, Munich, Germany. Dr Forte is an Attending, Department of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL. Dr Lentz is a Resident, Division of Plastic and Reconstructive Surgery, UCSF Medical Center, San Francisco, CA. Dr Durand is a Resident and Dr Raghu is an Attending, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT. Dr Kwei is an Attending, Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT.
Rachel
R
Lentz
Dr Teng is an Attending, Cosmetic and Plastic Surgery, Carolinas Medical Center, Charlotte, NC. Dr Broer is an Attending and Dr Heidekrueger is a Resident, Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM - Klinikum Bogenhausen Academic Teaching Hospital, Technical University, Munich, Germany. Dr Forte is an Attending, Department of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL. Dr Lentz is a Resident, Division of Plastic and Reconstructive Surgery, UCSF Medical Center, San Francisco, CA. Dr Durand is a Resident and Dr Raghu is an Attending, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT. Dr Kwei is an Attending, Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT.
Melissa
M
Durand
Dr Teng is an Attending, Cosmetic and Plastic Surgery, Carolinas Medical Center, Charlotte, NC. Dr Broer is an Attending and Dr Heidekrueger is a Resident, Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM - Klinikum Bogenhausen Academic Teaching Hospital, Technical University, Munich, Germany. Dr Forte is an Attending, Department of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL. Dr Lentz is a Resident, Division of Plastic and Reconstructive Surgery, UCSF Medical Center, San Francisco, CA. Dr Durand is a Resident and Dr Raghu is an Attending, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT. Dr Kwei is an Attending, Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT.
Madhavi
M
Raghu
Dr Teng is an Attending, Cosmetic and Plastic Surgery, Carolinas Medical Center, Charlotte, NC. Dr Broer is an Attending and Dr Heidekrueger is a Resident, Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM - Klinikum Bogenhausen Academic Teaching Hospital, Technical University, Munich, Germany. Dr Forte is an Attending, Department of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL. Dr Lentz is a Resident, Division of Plastic and Reconstructive Surgery, UCSF Medical Center, San Francisco, CA. Dr Durand is a Resident and Dr Raghu is an Attending, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT. Dr Kwei is an Attending, Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT.
Stephanie L
SL
Kwei
D000328:Adult; D059925:Anatomic Landmarks; D001940:Breast / Q000098:blood supply* / Q000601:surgery*; D019928:Breast Implantation / Q000295:instrumentation; D018427:Breast Implants; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012189:Retrospective Studies; D016896:Treatment Outcome