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Evaluation of nipple-areola complex sensitivity after the latero-central glandular pedicle technique in breast reduction

Moustapha Hamdi, Phillip Blondeel, Karlien Van de Sijpe, Koenraad Van Landuyt, Stan Monstrey
British Journal of Plastic Surgery 2003, 56 (4): 360-4

INTRODUCTION: Previous anatomical and clinical studies have shown that nipple-areola sensitivity decreased significantly after conventional superior and inferior pedicle technique for 3-6 months postoperatively. We found it necessary to modify our techniques in breast reduction to achieve a better outcome regarding breast sensation. Since 1999, we have been using a new technique of breast reduction with a latero-central glandular pedicle. The pedicle for the nipple-areola is based on a horizontal septum and it is designed to incorporate the anterior ramus of the lateral branch of the fourth inter-costal nerve and perforator vessels. Using this technique, a prospective study was conducted in order to quantitatively assess the nipple-areola sensitivity.

MATERIAL AND METHODS: The sensitivity of the nipple-areola complex (NAC) was evaluated in 20 consecutive patients undergoing breast reduction with the septum-based lateral pedicle technique. The sensitivity was assessed preoperatively, 2 weeks and 3 months postoperatively by the same examiner. The nipple and four cardinal points of the areola were tested. Pressure thresholds were measured with Semmes-Weinstein monofilaments, temperature sensitivity with hot (40 degrees C) and cold (4 degrees C) metal probes and vibratory thresholds with the Biothesiometer. Average sensation of the areola was calculated by means of the four areas tested.

RESULTS: Average values of different patterns of sensitivity decreased significantly on the tested areola 2 weeks postoperatively. Three months postoperatively, pressure and vibration values were statistically comparable in averages to preoperative values (nipple: 46.2+/-3.8 versus 34.6+/-2.2 g/mm2 and 6.4+/-1.2 versus 3.7+/-1 micron; areola: 57.4+/-5.7 versus 49+/-6.8 g/mm2 and 6.7+/-1.2 versus 3.1+/-0.6 micron). Concerning the ability to recognise temperature, 27.5 and 20% of patients could not distinguish between cold and hot 3 months after surgery, on the nipple and the areola, respectively. Numbness was found only on two NAC despite the significant decrease of sensitivity after 2 weeks. This may be attributed to postoperative oedema or neuropraxia.

CONCLUSION: Our results showed that using the latero-central glandular pedicle technique preserves the sensitivity of the NAC.

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