Importance of perforating vessels in nipple-sparing mastectomy: an anatomical description

Abstract

Background: Nipple-sparing mastectomy (NSM), understood as an oncologically valid procedure, is relatively new, and is an evolution of traditional mastectomy, particularly in relation to breast-conserving surgery. The anterior perforating branches are responsible for the cutaneous vascularization of the breast skin, and their preservation is a fundamental step to avoid possible postoperative necrosis. Therefore, evaluating the potential complications of cancer-related reconstructive surgical procedures such as NSM, both the distance of the tumoral lesion from the skin and the surgical incision site should be carefully considered. The preferred site of incision corresponds to the inframammary fold or possibly the periareolar area.

Methods: We retrospectively reviewed 113 patients who underwent NSM from January 2005 to October 2012 to evaluate skin complications. The anatomical study was performed by magnetic resonance imaging of the breast.

Results: Only one of the 113 women who had undergone a NSM procedure had total necrosis (0.9%) and six patients had partial necrosis (5.8%) of the nipple-areola complex.

Keywords: breast; breast anatomy; breast perforating vessels; magnetic resonance imaging; nipple-sparing mastectomy.

Figure 1

Maximum intensity projection post-processing three-dimensional angiographic reconstruction images on axial (A) and sagittal (B) view. Notes: In (A), evidence of enlarged hyperemic anterior perforating arteries are shown on the left breast. In (B) this is well depicted in three-dimensional magnetic resonance angiographic images of the origin of the perforating anterior branches from the internal thoracic arteries.

Figure 2

Maximum intensity projection post-processing three-dimensional magnetic resonance angiographic images on axial (A) and coronal (B) views. Notes: The right breast shows an enlarged hyperemic dorsal branch of the anterior perforating arteries, and (B) shows the origin of cutaneous and nipple-areolar vessels from the anterior perforating branch, known as “Major”.