INVESTIGATION OF BLOOD SUPPLY TO THE MAMMARY GLANDS BY MEANS OF FLUORESCENT ANGIOGRAPHY IN REDUCTION MAMMOPLASTY

Purpose of the study. To study the features of the surface blood supply of the nipple-areolar complex (NAC) in patients with macromastia in the preoperative period using fluorescent angiography, followed by the determination of the most stable dermoglandular vascular pedicle used for the transfer of NAC during operations to reduce the mammary glands (MG). Material and methods. The study was performed using the SPY Elite fluorescence angiography system (Stryker, Novadaq). The study was carried out among 21 patients (42 MG) who underwent reduction mammoplasty for macromastia. Angiography was performed twice - before surgery and at the time of cutting out the dermoglandular vascular pedicle. The results. A classification of the superficial blood supply to the NAC has been developed. According to the classification, the structure and features of blood supply in the studied mammary glands were studied. In 33% cases (14 MG (CI 19-47%)) the lateral group of vessels supplying the NAC was completely absent in the breast, in 24% cases (10 MG (CI 11-37%)) the upper group of vessels was absent and 5% cases (2 MG (CI 0-12%)) lacked the medial vessel group. When comparing the medial, superior and lateral zones using Fisher's exact test (medial and lateral p < 0.001, medial and superior p = 0.007), we can speak with high reliability of a more stable medial vascular, dermoglandular pedicle. When calculating the absolute values in 62% cases (13 women), there were cardinal differences in the NAC blood supply of the right and left MG. In all cases, a positive aesthetic result was achieved in the long-term period. In the structure of complications and negative consequences after reduction mammoplasty, unilateral total necrosis of the nipple-areola complex 2% (1 MG), dehiscence of the wound edges 7% (3 MG) were founded. Unilateral necrosis of the nipple-areola complex occurred due to misinterpretation of laser angiography data and failure to follow the detected features of blood supply to the NAC of the mammary gland. Conclusion. Preoperative diagnostics of the features of blood supply to the NAC using a laser angiography system can save practicing surgeons from such formidable complications of reduction mammoplasty as marginal or total necrosis of the NAC.

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