Arterial Supply of the Breast and Nipple-areola Complex: A MRI and Cadaveric Study

Abstract

Introduction: Preservation of the Nipple-areola Complex (NAC) is currently being attempted for a better aesthetic and functional outcome, necessitating precise knowledge of its vascular supply to minimise postoperative necrosis. Aim: To determine the source, branches, and pattern of arterial supply to breast parenchyma and the NAC using Magnetic Resonance Imaging (MRI) and cadaver. Materials and Methods: The present retrospective observational study was conducted in the Department of Anatomy, AIIMS, New Delhi, India, from March 2015 to October 2016. Total of 50 MRI scan images of female patients who underwent breast MRI as part of their preoperative assessment were collected and retrospectively reviewed. Cadaveric dissection was performed on 11 breasts (5 left and 6 right) obtained from 10 female cadavers with no breast pathology. Radiographic and cadaveric data pertaining to the source, branches, and pattern of arterial supply to breast parenchyma and the NAC were collected. Data was studied using statistical tests like Dunn test followed by Bonferroni correction and Signed-rank test. Results: The MRI scans revealed that most vessels bilaterally supplying the medial half of the breast originate from the Internal Mammary Artery (IMA), while those supplying the lateral half arise from the Lateral Thoracic Artery (LTA), and the branches of IMA were found to be consistently supplying the NAC. Cadaveric dissection confirmed, in all cases except one, that the principal parenchymal and NAC supply on either side arises from the IMA. Conclusion: IMA perforators supply the NAC most consistently and the major part of the breast parenchyma, as well. MRI breast is the most precise modality currently available for the preoperative evaluation of breast vascularity during conservative mastectomies.