Background: It is not easy to define normal breast size.
An accurate determination of breast size is useful in many
areas of breast surgery.
Objective: The goals of this research are to use CT Angiography
to examine the vascular supply to the nipple-areola
complex (NAC) and to determine whether changing surgical
planning based on preoperative CTA could decrease the
frequency of NAC necrosis after breast reductions in cases
that are thought to be at a high risk of nipple loss.
Patients and Methods: This single-arm interventional
study was performed on 30 patients complaining of breast
hypertrophy that were admitted to the Plastic and Reconstructive
Surgery Department in Tanta University Hospitals. A
single radiologist analyzed all of the patients' CT thoraces to
identify artery sources, the intercostal space that was penetrated,
the glandular/subcutaneous course, and the vascular
entrance site into the NAC of each breast. By using the CTA,
we knew the dominant blood supply of the breast and the
point of its entry to the NAC by using a clock pattern. According
to them, we chose the pedicle at the known time,
number and position determined by CTA. Marking of the
selected pedicle depending on the dominant blood supply of
the breast and the NAC according to the results of the CTA.
Results: NAC necrosis and lost NAC sensation didn't
occur in any patient. Bilateral decreased NAC sensation
occurred in 6 (20%) patients.As regards aesthetic outcome,
pseudo ptosis occurred in 3 (10%) patients, and asymmetry
occurred in 2 (6.66%) patients only. As regards scar complications,
hypertrophy and pigmentation didn't occur in any
patients; widening occurred in 2 (6.66%) patients, and dog
ear deformity occurred in 3 (10%) patients.
Conclusions: CTA identifies the dominant arterial supply
and provides useful details that enable wise preoperative
planning for breast pedicles. Although it is not indicated in
the majority of cases, our technique would be of benefit in
patients with gigantomastia and in cases of secondary reductions
if the prior pedicle design was uncertain.