The Use of Computerized Tomography Angiography in the Detection of the Dominant Blood Supply for Facilitation of Breast Reduction Pedicle Selection

Background: It is not easy to define normal breast size.An accurate determination of breast size is useful in manyareas of breast surgery.Objective: The goals of this research are to use CT Angiographyto examine the vascular supply to the nipple-areolacomplex (NAC) and to determine whether changing surgicalplanning based on preoperative CTA could decrease thefrequency of NAC necrosis after breast reductions in casesthat are thought to be at a high risk of nipple loss.Patients and Methods: This single-arm interventionalstudy was performed on 30 patients complaining of breasthypertrophy that were admitted to the Plastic and ReconstructiveSurgery Department in Tanta University Hospitals. Asingle radiologist analyzed all of the patients' CT thoraces toidentify artery sources, the intercostal space that was penetrated,the glandular/subcutaneous course, and the vascularentrance site into the NAC of each breast. By using the CTA,we knew the dominant blood supply of the breast and thepoint of its entry to the NAC by using a clock pattern. Accordingto them, we chose the pedicle at the known time,number and position determined by CTA. Marking of theselected pedicle depending on the dominant blood supply ofthe breast and the NAC according to the results of the CTA.Results: NAC necrosis and lost NAC sensation didn'toccur in any patient. Bilateral decreased NAC sensationoccurred in 6 (20%) patients.As regards aesthetic outcome,pseudo ptosis occurred in 3 (10%) patients, and asymmetryoccurred in 2 (6.66%) patients only. As regards scar complications,hypertrophy and pigmentation didn't occur in anypatients; widening occurred in 2 (6.66%) patients, and dogear deformity occurred in 3 (10%) patients.Conclusions: CTA identifies the dominant arterial supplyand provides useful details that enable wise preoperativeplanning for breast pedicles. Although it is not indicated inthe majority of cases, our technique would be of benefit inpatients with gigantomastia and in cases of secondary reductionsif the prior pedicle design was uncertain.