Vascular Reliability of Nipple-Areola Complex???Bearing Pedicles: An Anatomical Microdissection Study

Abstract

Background: Vascular-dependent necrosis of the nipple-areola complex following reduction mammaplasty is still present. Concerning anatomy, there is a lack of literature comparing the vasculature of different nipple-areola complex–bearing pedicles in detail. Including six arterial sources supplying the breast, this anatomical work intends to clarify arterial impact and vascular reliability of different nipple-areola complex–bearing pedicles. Methods: Microdissections of anterior chest walls following vessel filling with dye were performed to examine the architecture of the arteries supplying the breast and their contribution to the blood supply of the nipple-areola complex on seven female corpses (14 breasts). Results: Four of six arterial sources supporting the breast were found to be mainly responsible for the blood supply of the nipple-areola complex. These are, in descending order of reproducibility, branches originating from the lateral thoracic artery, the internal mammary artery, the anterior branches of the intercostal arteries, and those deriving from the highest thoracic arteries. Despite vessel variability, both arrangements and subcutaneous courses of arteries advancing to the nipple-areola complex showed characteristic relationships. Conclusions: Vascular variability and overlap may account for the remarkable safety of diverse nipple-areola complex–bearing pedicles, even though pedicle thickness influences vascular reliability. Lateral and medial approaches, however, clearly show vascular advantages over that which can be observed in inferior and superior pedicles. The former may therefore be regarded as more reliable. Especially the full-thickness glandular dermal superolaterally based pedicle should regularly enclose dominant branches originating from the lateral thoracic artery and supplementary arteries deriving from minor important sources in this region.