Abstract
BACKGROUND: Breast hypertrophy is a condition of increased breast volume, occurring at different ages, causing many psychological and physiological problems such as back pain, inflammation of the inframammary folds, and psychological stress1. OBJECTIVE: This study aimed to identify the main arterial sources of blood supply to the nipple-areola complex (NAC), which may apply to extensive hypertrophic breast reduction surgeries. METHODS: Describe a cross-sectional, uncontrolled clinical case series to evaluate the most accurate blood supply to the NAC based on angiography for all patients diagnosed with excessive breast enlargement requiring surgery. RESULTS: 30 female patients were diagnosed with hypertrophic breasts with a minimum volume of 1005cc and a maximum of 2412 cc. Multi-slice computed tomography (MSCT) was indicated preoperatively to determine the blood supplies to the breast; the internal mammary artery (IMA) predominates in 60/60 breasts (100%), and the lateral thoracic artery predominates in 21/60 breasts (35%). Based on the MSCT scan results, the axial flap design carrying the NAC complex has a dominant branch entirely from the IMA: superior medial pedicle in 48/60 breasts (80%), superior pedicle in 11/60 breasts (18.33%) and medial pedicle in 1/60 breasts (1.67%). None of the breasts showed signs of nipple-areola necrosis after surgery, and only two cases (3.3%) of partial NAC necrosis occurred, both in superior flaps. CONCLUSION: Preoperative breast MSCT imaging helps select the type of pedicle that supplies blood to the NAC and minimizes the risk of NAC necrosis during breast reduction surgery in cases of significant hypertrophy and severe grades of ptosis.