Preservation of the nipple-areolar complex during subcutaneous mastectomy: A surgical and diagnostic method.

Abstract

Simultaneous oncological and reconstructive plastic surgery on the mammary gland in the treatment of cancer is currently one of the important stages in the psychological rehabilitation of patients. In order to achieve a good cosmetic result, reconstruction must be performed simultaneously with radical surgical treatment. Currently, there are a large number of methods for performing breast reconstruction. One of the most commonly used is radical subcutaneous/skin-sparing mastectomy with simultaneous reconstruction with a silicone endoprosthesis. Grand W Carlson type technique is used, with skin incisions in the form of an inverted T is usually performed in patients with large mammary gland with severe grade III ptosis, as the patients usually require reduction of excess skin. However, the most vulnerable aspects of this type of reconstruction is the impossibility of preserving the nipple-areolar complex (NAC), which is associated with a high risk of developing such complications as partial/complete necrosis of the NAC. The current study provides an overview of an original method to decrease the risk of necrosis of NAC with evaluation of blood supply of the nipple and inferior deepithelialized flap using real-time intraoperative Doppler ultrasonography and indocyanine green fluorescence system.