The Use of Computerized Tomography Angiography in the Detection of the Dominant Blood Supply for Facilitation of Breast Reduction Pedicle Selection,, | ||||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
| Articles in Press, Accepted Manuscript, Available Online from 03 April 2023 | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejprs.2023.200533.1267 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Tarek Gamal Shoukr  1; Noura G Yousef2; Sayed Mandour3
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| 1Plastic and reconstructive surgery dep Tanta University | ||||
| 2Plastic and reconstructive surgery dep Tanta University | ||||
| 3Tanta Faculty of Medicine, Tanta; Egypt | ||||
| Abstract | ||||
| Background: It is not easy to define normal breast size. An accurate determination of breast size is useful in many areas of breast surgery. 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. | ||||
| Keywords | ||||
| Nipple areola complex; Suprasternal notch to the nipple; Computerized tomographic angiography | ||||
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