24.0: Thursday, March 17, 2005

Avoiding Free Nipple Grafts during reduction mammaplasty in gigantomastia patients

Melinda Lacerna, MD, Carlos Medina, Adam Angeles, Julie Spears, and Amit Mitra.

Introduction:Gigantomastia (>2000 gm excision per breast) was traditionally approached with breast amputation/free nipple grafting during reduction mammaplasty. Disadvantages include loss of sensation, poor projection, hypopigmentation, and decreased lactation ability.We report our experience with the inferior pedicle technique and successful preservation of the nipple-areola complex for patients with gigantomastia. Methods: All reduction mammaplasty procedures(2001-2003)were reviewed. The Wise keyhole pattern was utilized pre-operatively. Follow-up was from 1 week to 1 year post-operatively.Results: Out of 173 patients,15 patiens(ages 19-45)were identified. Excised specimens ranged from 2000-4000 grams per side. The largest breast cup size was 56 L, the longest supraclavicular to nipple distance was 48 cm, and the longest pedicle length was 38 cm. The width of the inferior pedicle base was maintained at 10-17 cm(wider than the classic 4-10 cm).No significant complications were noted. One patient experienced bilateral partial nipple desquamation, yet maintained sensation and healed well with moist dressings. All patients achieved satisfactory aesthetic outcomes.Conclusion: Breast amputation with free nipple grafting should no longer be considered as standard practice for gigantomastia patients. Maintaining a wider base and meticulous intraoperative handling of the inferior pedicle may contribute to the preservation of viability and sensation of the nipple-areolar complex in this patient population.