Plastic Surgery>>>>>Breast, trunk and perineum
Question 10#

The most reliable technique of breast reduction to preserve NAC sensitivity is:

A. The superior pedicle
B. The inferior pedicle
C. Würinger’s septum-based pedicle
D. The supermedial pedicle
E. The lateral pedicle

Correct Answer is C

Comment:

Würinger’s septum-based pedicle. Using a central pedicle or laterally based inferior pedicle technique resulted in loss of nipple sensitivity in 9.5% of breasts and correlated with increasing breast size and amount of resection. When <440g per breast was resected, nipple sensation was retained 100% of the time. Loss of sensation to the nipple can occur after any kind of breast reduction, but some subgroups of patients and reduction techniques are associated with a higher incidence of nipple sensitivity loss than others. Inferior pedicle techniques retain NAC sensitivity better than the superior pedicle techniques during the first 3 months postoperatively. At 6 months postoperatively NAC sensation was comparable between the two techniques. Medial pedicle techniques seem to retain similar NAC sensation as compared with the inferior pedicle technique. Mammaplasty techniques which are based on Würinger’s septum seem to preserve sensation to the NAC better. This is a ligamentous suspension of the breast consisting of a horizontal septum attaching the NAC to the thoracic wall at the level of the fifth rib. It also includes branches and perforators from the intercostal, thoraco-acromial, and lateral thoracic vessels as well as the deep branch of the 4th intercostal nerve. Including the septum in a lateral pedicle technique will provide better NAC sensitivity than a traditional superior or inferior pedicle technique.

References:

1. Gonzalez F, Brown FE, Gold ME, Walton RL, Shafer B. Preoperative and postoperative nipple-areola sensibility in patients undergoing reduction mammaplasty. Plast Reconstr Surg 1993; 92(5): 809-14.
2. Hamdi M, Greuse M, DeMey A, Webster MHC. A prospective quantitative comparison of breast sensation after superior and inferior pedicle mammaplasty. Br J Plast Surg 2001; 54(1): 39-42.
3. Nahabedian MY, Mofid MM. Viability and sensation of the nipple-areola complex after reduction mammaplasty. Ann Plast Surg 2002; 49(1): 24-31.
4. Würinger E, Mader N, Posch E, Holle J. Nerve and vessel supplying ligamentous suspension of the mammary gland. Plast Reconstr Surg 1998; 101(6): 1486-93.
5. Hamdi M, Blondeel P, Van de Sijpe K, Van Landuyt K, Monstrey S. Evaluation of nipple-areola complex sensitivity after the latero-central glandular pedicle technique in breast reduction. Br J Plast Surg 2003; 56(4): 360-4.