Skin circulation in the nipple after bipedicle dermal flap reduction

Abstract

Avascular necrosis of the nipple is a serious complication of reduction mammaplasty with nipple transposition. A frequency of fat necrosis of 2.1% and a total or partial necrosis of 0.3% has been reported in the literature [1]. In performing reduction mammaplasty different kinds of pedicles can be used such as the horizontal bipedicle, medial or lateral or vertical bipedicle, or inferior based pedicles. The perfusion of the nipple-areola complex is especially important while performing operations for cosmetic purposes. Its blood supply arises medially and cranially from the internal thoracic artery, and laterally and inferiorly from the lateral thoracic artery and the intercostal arteries. By a combination of two techniques, laser Doppler flowmetry (LDF) and fluorescein flow-metry (FF), it is possible to measure the changes in blood flow at the different operative steps and also to determine whether the blood flow in the nipple is homogeneous. LDF measures the product of the number of erythrocytes and their velocity in arbitrary units within a sphere of a radius of 1-2 mm [2]. FF is so far based on a photographic procedure and measures the transca-pillary exchange of sodium fluorescein, expressed as a fluorescence index, within a circular area of a diameter of 2 mm on the film negative, corresponding to 1 cm in natural size. The fluorescence is emitted from a tissue depth of 0.6 mm [3]. Nowadays, adrenaline is used to reduce blood loss which also temporarily influences the blood flow. The blood flow during the different steps in the operative procedure in performing a reduction mammaplasty was studied. © 2009 Springer-Verlag Berlin Heidelberg.