title: Computed Tomographic Angiography-Based Characterization of Source Blood Vessels for Nipple-Areola Complex Perfusion in Hypertrophic Breasts.
abstract: BACKGROUND
  Current knowledge about the blood supply of the nipple-areola complex (NAC) has largely been derived from studies on cadavers or persons with breasts of normal size. The aim of this study was to identify and classify the NAC blood supply by computed tomographic angiography (CTA) examination in female volunteers with breast hypertrophy.
  
  
  METHODS
  CTA examination was performed on hypertrophic breasts of 23 female subjects. The main blood supplies were revealed through image data analyses. The dominant blood supply of the NAC and its vascular sources were identified and sorted. The detectable diameter threshold of blood vessels was set beyond 1.0 mm.
  
  
  RESULTS
  A total of 61 dominant blood vessels were identified. The source arteries were traced as the internal thoracic artery (ITA, 50.8%), lateral thoracic artery (LTA, 27.8%), thoracoacromial artery (TA, 14.8%), brachial artery (BA, 3.3%), and axillary artery (AA, 3.3%), and the corresponding reproducibility of these source vessels was 31, 37, 9, 4.3, and 4.3%, in all breasts. The intercostal artery (IA) was not identified as a dominant NAC supplying vessel in any CTA scan image. Twenty-six breasts had only one dominant artery, whereas 17 breasts showed multiple dominant blood supplies. Three breasts showed no dominant blood vessels of the NAC, with diameters greater than the detectable threshold of 1.0 mm, and 52.2% of the breasts demonstrated anatomically symmetrical patterns of blood supply for the NAC.
  
  
  CONCLUSIONS
  The ITA, LTA, and TA are likely to be the main vessel sources, whereas the IA is unlikely to be the dominant vessel for NAC perfusion, on the basis of the studied breasts. An asymmetrical pattern of bilateral breast blood supply was demonstrated in a considerable portion of the females with breast hypertrophy in this study.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi'an, 710032, Shaanxi, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi'an, 710032, Shaanxi, China.
authors.forename: Yingjun
authors.initials: Y
authors.lastname: Su
authors.affiliation: Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
authors.forename: Minwen
authors.initials: M
authors.lastname: Zheng
authors.affiliation: Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
authors.forename: E
authors.initials: E
authors.lastname: Bei
authors.affiliation: Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi'an, 710032, Shaanxi, China.
authors.forename: Lihong
authors.initials: L
authors.lastname: Qiu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi'an, 710032, Shaanxi, China.
authors.forename: Zhaoxiang
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi'an, 710032, Shaanxi, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Geng
authors.affiliation: Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi'an, 710032, Shaanxi, China. yichg@163.com.
authors.forename: Chenggang
authors.initials: C
authors.lastname: Yi
mesh_terms: D000293:Adolescent; D000328:Adult; D001366:Axillary Artery / Q000000981:diagnostic imaging; D015992:Body Mass Index; D001916:Brachial Artery / Q000000981:diagnostic imaging; D001940:Breast / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D002681:China; D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging* / Q000601:surgery*; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000000981:diagnostic imaging; D008875:Middle Aged; D009558:Nipples / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D013895:Thoracic Arteries / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Computed tomographic angiography; Hypertrophic breast; Main blood supply; Nipple–Areola complex