Patient Characteristics Associated with Free Nipple Graft Reduction Mammoplasty

Andrea Y Lo,Roy P Yu,Sarah Wang,Ketan M Patel,Alex K Wong,Wesley Schooler,Maxwell Johnson,Haig L Manoukian,Regina Y Baker,Phillip Khim,Joseph Carey,Anjali Raghuram

doi:10.7759/cureus.9063

Abstract

Purpose: Surgical approaches for reduction mammoplasty most commonly incorporate a parenchymal vascular pedicle. For patients with larger breasts where pedicle viability may be compromised due to excessive length, the free nipple graft (FNG) technique provides a safe alternative. Criteria for whether a patient should undergo a FNG remains controversial due to variable reports in the literature with small sample sizes and inherent surgeon-dependent bias. To address this, we sought to investigate perioperative factors associated with performing FNGs at our institution in order to better elucidate specific indications for this surgery.Methods: A retrospective chart review was performed for 323 patients who underwent a reduction mammoplasty from August 2009 to July 2019 at Keck Hospital and LAC+USC Medical Center. Data regarding patient demographics, comorbidities, pre-operative breast characteristics, and post-operative complications were extracted. Studentʼs t-test, Fisherʼs exact test, and logistic regression were performed in R.Results: Of 323 patients, 15 received an FNG. Independent variables analyzed included: age, body mass index (BMI), obesity, smoking, diabetes, hypertension, surgical indication, sternal notch-to-nipple length, nipple-to-inframammary fold length, and weight of breast specimens removed. BMI, obesity, gigantomastia, and weight of specimen resected were significantly associated with use of the FNG (p < 0.001, p < 0.05, p < 0.0001, p < 0.0001, respectively). Regression analysis revealed that patients who had an average of more than 1500 g of tissue removed from each breast were 1.41 (95% CI: 1.17-1.71, p<0.001) times more likely to undergo an FNG procedure than those who had less than 1500 g of tissue removed. Demographic data and breast characteristics, such as notch-to-nipple length and nipple-to-inframammary fold length, were not significantly associated.Conclusion: Total weight of the breast specimens removed and BMI were significantly associated with the FNG technique. Removing more than 1500 g gof total breast tissue was also significantly correlated. These findings may guide surgeons during the decision-making process of when to use an FNG.

Highlights

Women with excessive breast hypertrophy or macromastia suffer from a number of complaints, including chronic neck, shoulder, and back pain, intertrigo, impaired self-esteem, and compromised physical functioning [1]
body mass index (BMI), obesity, gigantomastia, and weight of specimen resected were significantly associated with use of the free nipple graft (FNG) (p < 0.001, p < 0.05, p < 0.0001, p < 0.0001, respectively)
Regression analysis revealed that patients who had an average of more than 1500 g of tissue removed from each breast were 1.41 times more likely to undergo an FNG procedure than those who had less than 1500 g of tissue removed

Summary

Introduction

Women with excessive breast hypertrophy or macromastia suffer from a number of complaints, including chronic neck, shoulder, and back pain, intertrigo, impaired self-esteem, and compromised physical functioning [1]. Reduction mammoplasty, or surgical resection of breast parenchymal tissue, is an effective procedure that is commonly performed by plastic surgeons. Proposed techniques for reduction mammoplasty differ in terms of skin incision placement, tissue resection patterns, and retention of blood supply to the remaining breast tissue and areolar complex [2]. These techniques are limited in terms of their applicability for significant breast hypertrophy, or gigantomastia. For patients who need removal of greater than 1000 g of breast tissue, plastic surgeons have advocated against the use of pedicle techniques. Given the questionable pedicle viability in this patient population, these techniques are thought to increase the risk of nipple areolar complex (NAC) ischemia and subsequent necrosis [5]

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