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Preservation of internal mammary perforators in nipple sparing breast reconstruction: a novel technique for improving nipple areolar complex viability
Lara Devgan Verdonck, MD, MPH, Alexander Swistel, MD, FACS, Mia Talmor, MD, FACS.
New York Presbyterian Hospital, the University Hospital of Columbia and Cornell, New York, NY, USA.

BACKGROUND:
As nipple sparing mastectomies become increasingly preferred by both patients and oncologic surgeons, more attention is being paid to technical factors that increase perfusion and viability of the nipple areolar complex. This paper describes the technique of using preoperative Doppler ultrasonography to identify and preserve internal mammary artery perforators, with the aim of improving vascular supply and survival of the nipple areola complex and breast flaps, following both mastectomy and subsequent breast reconstruction.
METHODS:
Patients who underwent nipple sparing mastectomies for breast cancer treatment were collected. Those with prior breast surgery, including breast reductions, breast augmentations, mastopexies, and prior mastectomies, were excluded. Internal mammary artery perforators were determined with handheld 8-MHz linear probe Doppler ultrasonography and marked preoperatively. Intraoperative dissection was carried medially with careful preservation of the dopplered and marked perforators. Tissue expander or implant reconstruction was then performed in the standard fashion, using a subpectoral plane.
RESULTS:
Over 20 patients underwent nipple sparing mastectomies for breast cancer treatment, with either immediate tissue expander reconstruction and subsequent exchange for permanent implants, or single stage breast reconstruction. All patients demonstrated aesthetically acceptable results with no evidence of nipple areolar complex necrosis, breast flap necrosis, or wound complications in post-operative follow up. Our figures illustrate a step-by-step approach to the novel internal mammary artery dopplering technique utilized.
CONCLUSION:
Preoperative dopplering and preservation of internal mammary artery perforators in nipple sparing mastectomy is a safe, effective, and aesthetic adjunctive technique in optimizing nipple areolar complex and breast flap survival.


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