Aesthetic Surgery Journal最新文献

{"title":"Timing of Acellular Dermal Matrix Placement in 2-Stage Breast Reconstruction: Effects on Contracture and Complications.","authors":"Jaehong Liu, Eun-Jung Yang, Seung Yong Song","doi":"10.1093/asj/sjag063","DOIUrl":"10.1093/asj/sjag063","url":null,"abstract":"<p><strong>Background: </strong>Acellular dermal matrix (ADM) is commonly used in implant-based breast reconstruction, but the optimal timing of ADM use in prepectoral 2-stage reconstruction remains uncertain.</p><p><strong>Objectives: </strong>The authors evaluated whether delaying ADM application to the second-stage implant exchange (after initial tissue expansion without ADM) decreases meaningful capsular contracture without increasing reconstructive failure.</p><p><strong>Methods: </strong>The authors performed a retrospective cohort study of adult women undergoing immediate, prepectoral 2-stage tissue expander reconstruction at a single institution. Patients were stratified by ADM timing: ADM was placed at first-stage expander insertion vs delayed ADM applied at second-stage implant exchange with full implant wrapping. The primary outcome was tissue expander loss. Secondary outcomes included seroma, hematoma, infection, and capsular contracture graded by the Baker scale. Multivariable logistic regression adjusted for covariates, including BMI, mastectomy weight, chemotherapy, and cancer stage.</p><p><strong>Results: </strong>Tissue expander loss did not differ between groups. Overall early postoperative complication patterns were similar; however, delayed ADM use was associated with more seroma events among patients who received postmastectomy radiotherapy and/or underwent axillary lymph node dissection. After definitive implant placement, delayed ADM application was associated with a lower incidence of clinically significant capsular contracture (Baker grade III/IV: 4.4% vs 25.0%, P = .014) compared with ADM placement at the first stage, and this association persisted after covariate adjustment (adjusted odds ratio 0.13, 95% CI, 0.02-0.89; P = .038).</p><p><strong>Conclusions: </strong>In prepectoral 2-stage reconstruction, deferring ADM to the implant-exchange stage may reduce capsular contracture without increasing expander loss. Because seroma risk may be higher in patients receiving radiotherapy and/or axillary surgery, ADM timing should be individualized and paired with seroma-mitigation strategies in higher-risk patients.</p><p><strong>Level of evidence: 3 (therapeutic): </strong>For image description, please refer to the figure legend and surrounding text.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"1109-1115"},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Breast Reconstruction Strategies Using Exclusive Lipofilling or Prosthesis After Total Mastectomy for Breast Cancer: Satisfaction and Morbidity After More Than 2 Years.","authors":"Matthieu Beque, Gabrielle Aubry, Jean-Christophe Bichet, Catherine Uzan, Geoffroy Canlorbe","doi":"10.1093/asj/sjaf174","DOIUrl":"10.1093/asj/sjaf174","url":null,"abstract":"<p><strong>Background: </strong>Total mastectomy for breast cancer is an impactful procedure, and breast reconstruction plays a crucial role for women diagnosed with the disease.</p><p><strong>Objectives: </strong>The objective of the authors of this study is to compare satisfaction, morbidity, and timelines of 2 breast reconstruction techniques after breast cancer: breast prosthesis and exclusive lipofilling.</p><p><strong>Methods: </strong>This is a comparative, retrospective, unicentric study on patients who underwent total mastectomy between May 2014 and May 2020. Satisfaction is assessed using the BREAST-Q questionnaire at least 2 years after the start of the reconstruction (4.8 [±0.16] years in the implant group and 5.4 [±0.12] years in the lipofilling group, P = .044). Morbidity is evaluated using the Clavien-Dindo classification.</p><p><strong>Results: </strong>One hundred and one patients were included in the study (60 in the prosthesis group and 41 in the lipofilling group). The response rate to the questionnaire was 63.3% (38 patients) in the prosthesis group and 70.7% (29 patients) in the lipofilling group. The lipofilling technique appears to provide better satisfaction for the \"sexual well-being\" item of the BREAST-Q in multivariate analysis (65.75 ± 1.92 vs 54.87 ± 1.46, multivariate P = .03). The major complication (Grade III, IV or V) rate was 20% in the prosthesis reconstruction group compared with 0% in the lipofilling group (multivariate P= .05). Lipofilling often requires longer reconstruction times, but reoperations are more frequent in prosthesis reconstruction, extending the reconstruction periods.</p><p><strong>Conclusions: </strong>These data should be confirmed by other studies to better guide the choice of reconstruction type.</p><p><strong>Level of evidence: 3 (therapeutic): </strong>For image description, please refer to the figure legend and surrounding text.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"NP118-NP126"},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Tranexamic Acid Reduces Perioperative Blood Loss in Reduction Mammoplasty With Immediate Implant-Based Reconstruction: A Randomized, Triple-Blinded, Placebo-Controlled Trial.","authors":"Jerzy Kolasiński, Tomasz Reysner, Małgorzata Kolenda, Szymon Kołacz, Małgorzata Reysner","doi":"10.1093/asj/sjaf258","DOIUrl":"10.1093/asj/sjaf258","url":null,"abstract":"<p><strong>Background: </strong>Postoperative hematoma and oozing can compromise outcomes after reduction mammoplasty with immediate reconstruction. Intravenous (IV) tranexamic acid (TXA) is antifibrinolytic, but prospective evidence in this setting is limited.</p><p><strong>Objectives: </strong>The aim of this study was to determine whether a single pre-incision dose of IV TXA reduces perioperative blood loss and fibrinolytic activation vs placebo.</p><p><strong>Methods: </strong>In this randomized, triple-blinded, placebo-controlled trial, 60 women (American Society of Anesthesiologists I/II, 18-75 years) undergoing bilateral reduction mammoplasty with immediate implant-based reconstruction received TXA 10 mg/kg in 100 mL saline or placebo 10 min before incision. The primary outcome was total blood loss within 24 h (intraoperative suction + swab plus drain output). Secondary outcomes were perioperative changes in hemoglobin, D-dimer and fibrinogen, and complications within 30 days. Intention-to-treat analyses were performed.</p><p><strong>Results: </strong>All patients completed follow-up. Total blood loss was lower with TXA than with placebo (mean ± standard deviation: 221.1 ± 72.4 vs 298.1 ± 90.6 mL; mean difference -77.0 mL; 95% CI, -122.4 to -31.6; P = .001). Intraoperative loss and 24 h drain output were also reduced. Postoperative D-dimer rise was attenuated with TXA (0.31 ± 0.15 vs 0.49 ± 0.22 µg/mL; P = .002); hemoglobin decline was smaller. No thromboembolic, neurologic, or allergic events occurred; no skin-flap necrosis was observed.</p><p><strong>Conclusions: </strong>Pre-incisional IV TXA safely reduces perioperative bleeding and fibrinolytic activity after reduction mammoplasty. These findings support incorporation of IV TXA into perioperative protocols.</p><p><strong>Level of evidence: 2 (therapeutic): </strong>For image description, please refer to the figure legend and surrounding text.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"1084-1091"},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noncontrast Magnetic Resonance Angiography vs Contrast-Enhanced Computed Tomography in Deep Inferior Epigastric Perforator Flap Planning: A 4-year Noninferiority Cohort Study.","authors":"Dmitry V Melnikov, Elina I Abdeeva, Sebastian Cotofana, Semyon I Ivanov, Nikolay A Ratushniy, Alexander V Vorontsov, Victor A Gombolevskiy","doi":"10.1093/asj/sjag140","DOIUrl":"10.1093/asj/sjag140","url":null,"abstract":"<p><strong>Background: </strong>Contrast-enhanced computed tomography angiography (CTA) is considered the \"gold standard\" in deep inferior epigastric perforator (DIEP) planning, despite its use of iodine-based contrast and ionizing radiation exposure. In contrast, magnetic resonance angiography (MRA) provides a radiation-free alternative, but conventional MRA requires the use of an expensive and potentially harmful gadolinium-based contrast agent. The development of contrast-free MRA protocols that preserve perforator mapping accuracy represents a promising area of investigation in DIEP flap planning.</p><p><strong>Objectives: </strong>The aim of this study was to evaluate whether an optimized noncontrast MRA protocol is noninferior to contrast-enhanced CTA in planning for delayed DIEP flap breast reconstruction (BR).</p><p><strong>Methods: </strong>This cohort study included 131 women (mean age 45.6 ± 7.1; BMI 28.5 ± 3.9 kg/m2), who underwent delayed unilateral DIEP flap BR. Group 1 (n = 81) underwent a noncontrast MRA with tailored preprocedural preparation, positioning, and scanning. Group 2 (n = 50) underwent standard contrast-enhanced CTA.</p><p><strong>Results: </strong>MRA significantly reduced operative time (333.0 ± 30.4 vs 348.9 ± 28.8 min; P = .003) and pedicle dissection time (35.7 ± 8.2 vs 40.1 ± 5.9 min; P < .001). The mean fascial incision length was shorter in the MRA group (9.1 ± 1.5 vs 10.6 ± 1.6 cm; P = .025). Diagnostic accuracy was 98.8% vs 99.6% (P = .4145); sensitivity was 98.3% vs 100.0%, and positive predictive value was 97.5% vs 98.7%, for MRA and CTA, respectively. The mean localization difference (ΔL) was 7.38 ± 2.59 vs 6.96 ± 2.34 mm (P = .238). Perfusion-related complication rates did not differ significantly between groups (P > .05). No significant differences were observed in baseline perforator characteristics.</p><p><strong>Conclusions: </strong>Optimized noncontrast MRA is a clinically reliable, noninferior alternative to CTA in DIEP flap planning, with additional advantages of reduced operative and dissection times.</p><p><strong>Level of evidence: 3 (therapeutic): </strong>For image description, please refer to the figure legend and surrounding text.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"1137-1146"},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Inferior Epigastric Perforator In-Basket? Evaluation of Patient Electronic Communication Following Autologous Breast Reconstruction.","authors":"Skyler K Palmer, Ananya Shah, Zain Aryanpour, David Le, Julian Winocour, Christodoulos Kaoutzanis, David W Mathes, Katie G Egan","doi":"10.1093/asj/sjaf177","DOIUrl":"10.1093/asj/sjaf177","url":null,"abstract":"<p><strong>Background: </strong>Patient electronic communication (PEC) through secure messaging is important for patient engagement. Although PEC has been studied in primary care, data on surgical specialties, particularly plastic surgery, remain limited.</p><p><strong>Objectives: </strong>The authors of this study assessed the volume and content of postdischarge PECs among patients undergoing postmastectomy autologous breast reconstruction.</p><p><strong>Methods: </strong>The authors conducted a retrospective mixed-methods study of PECs from patients undergoing autologous breast reconstruction at a large academic institution from January 2021 to December 2023. Primary outcomes included the quantity and thematic content of PECs sent within 30 days postdischarge. Covariates of interest included patient demographics, comorbidities, and operative details. Quantitative analysis included descriptive statistics and multivariable regression to identify predictors of PEC frequency. Qualitative content analysis was used to identify thematic categories of PECs.</p><p><strong>Results: </strong>A total of 297 patients underwent autologous breast reconstruction from January 2021 to December 2023. Of these, 230 patients (77.44%) sent 806 PECs within 30 days postdischarge. The most frequent message topics related to drains, wounds, pain, and activity restrictions. Younger age was a significant negative predictor of total PEC volume (P < .001) and wound-related (P = .021) or pain-related (P < .001) PECs, whereas immediate reconstruction was associated with more wound-related messages (P = .011). Depression was a positive predictor of pain-related PECs (P = .029).</p><p><strong>Conclusions: </strong>This is the first comprehensive study where the authors evaluated the quantity and content of postdischarge PECs in a large cohort of patients undergoing autologous breast reconstruction. Understanding the volume and content of PEC following autologous breast reconstruction may inform strategies for improving perioperative patient education.</p><p><strong>Level of evidence: 4 (therapeutic): </strong>For image description, please refer to the figure legend and surrounding text.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"NP110-NP117"},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstructing Aesthetics: Aesthetic Surgery Journal and Aesthetic Breast Reconstruction.","authors":"Maurice Y Nahabedian, Nolan Karp","doi":"10.1093/asj/sjag041","DOIUrl":"10.1093/asj/sjag041","url":null,"abstract":"","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":"46 10","pages":"1051-1053"},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Serum From Breast Implant-Exposed Patients Decreases Breast Cancer Cell Viability: Evidence for Immunosurveillance.","authors":"Puja Jagasia, Mariana Eduardo, Meryl Pearl Franco, Joshua DeYoung, David Dolivo, Seok Hong, Robert Galiano, Susan Clare, Seema Khan, John Y S Kim, Megan E Fracol","doi":"10.1093/asj/sjaf202","DOIUrl":"10.1093/asj/sjaf202","url":null,"abstract":"<p><p>Epidemiologic and preclinical studies suggest a potential protective effect of breast implants against breast cancer, but underlying mechanisms remain unclear. The authors hypothesize that local inflammation after breast implant placement induces immunosurveillence. The authors of this study investigated whether serum from implant-exposed (IE) women reduced breast cancer cell viability compared with implant-naive (IN) women, and whether antibodies mediated this effect. Serum from IE and IN women with high or low antibody levels against estrogen receptor-alpha, mucin-1, or mammaglobin-A was incubated with cancer cell lines overexpressing each antigen (MCF7, T47D, and SKBR3, respectively). 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide (MTT) assays measured cell viability. Rescue experiments utilized recombinant antigen to neutralize antibodies. Thirty-six patients were enrolled, and 12 samples were used to assess viability for each cell line. Serum with high antibody concentrations reduced cell viability compared with serum with low antibody concentrations across all cell lines. IE serum reduced cell viability compared with IN serum across all cell lines. Rescue experiments reversed differences between high and low antibody serum, as well as between IE and IN serum, implicating antibodies as the mediators of reduced viability. Peripheral serum from IE women decreased breast cancer cell viability compared with IN women, even when matched for the same antibody levels. Antibody neutralization reversed differences. This suggests implant exposure altered antibody function or other serum components. These findings support the hypothesis that the inflammatory response to breast implants may increase breast cancer immunosurveillance, although significantly more work is needed to confirm a mechanism. Level of Evidence: 3 (Therapeutic) For image description, please refer to the figure legend and surrounding text.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"1062-1067"},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring the Unmeasurable: Challenges Associated With Objective Assessment of Aesthetic Outcomes Following Breast Reconstruction.","authors":"Maurice Y Nahabedian, Anissa G Nahabedian","doi":"10.1093/asj/sjag116","DOIUrl":"10.1093/asj/sjag116","url":null,"abstract":"<p><p>Current approaches for assessing breast reconstruction outcomes are based on subjective and objective criteria. Subjective analysis is often performed by assessing patient-reported outcomes, of which the BREAST-Q is most common. Objective analysis is often performed by photographic analysis of various breast parameters based on a grading scale that can be numeric or qualitative (poor-excellent). Both are useful, but both are also limited in that the subjective and objective assessments may not correlate. This paper explores the current role, strengths, and limitations of these assessment tools and what is on the horizon. Level of Evidence: 5 (Therapeutic) For image description, please refer to the figure legend and surrounding text.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":"46 10","pages":"1047-1050"},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preserving Hip Projection in Lower Body Lift (Buttock Lift) Surgery: A Novel Adipofascial Flap Technique.","authors":"Christopher Patronella, Jared W Garlick, Chris Collins","doi":"10.1093/asj/sjag109","DOIUrl":"10.1093/asj/sjag109","url":null,"abstract":"<p><strong>Background: </strong>Flattening of the hip with masculinization and lack of buttock projection are common consequences of buttock lift procedures in women. Rotational axial flaps provide central and lower buttock volume but often lack enough remaining tissue to provide hip and upper buttock projection.</p><p><strong>Objectives: </strong>We describe a buttock lift technique utilizing a well-vascularized, broadly-based \"sliding\" adipofascial flap to preserve and enhance hip and upper buttock projection, while using autologous fat grafting for central and lower buttock volume.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all female patients who underwent buttock lift surgery with an autologous adipofascial flap by C.P. between January 2015 and December 2020.</p><p><strong>Results: </strong>A total of 145 female patients underwent buttock lift surgery with a sliding adipofascial flap, 132 (91%) receiving concomitant fat grafting of the central and lower buttocks. Average follow-up was 9.7 months (2-48 months). Average patient age was 46 (23-68), and average BMI was 28.3 (17-39.6). The overall patient complication rate for all procedures performed was 17.2%, and the complication rate for the buttock lift procedure alone was 8.3%. No instance of adipofascial flap necrosis occurred.</p><p><strong>Conclusions: </strong>The sliding adipofascial flap provides an alternative for volume enhancement in buttock lift surgery, prioritizing use of the valuable hip-flank adipose tissue for more proximal upper buttock and hip projection while relying on autologous fat grafting for the more distal central and lower buttock. This retrospective review demonstrates a strong safety profile with predictable aesthetic outcomes.</p><p><strong>Level of evidence: 4 (therapeutic): </strong>For image description, please refer to the figure legend and surrounding text.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"1147-1158"},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous Drainage and Nipple-Areolar Complex Necrosis After Nipple-Sparing Mastectomy: A Cadaveric and Prospective Clinical Cohort Study.","authors":"Sehoon Yoon, Seong Oh Park, Nobuaki Imanishi, Ying Zhu, Hak Chang","doi":"10.1093/asj/sjag125","DOIUrl":"10.1093/asj/sjag125","url":null,"abstract":"<p><strong>Background: </strong>Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction (IBBR) offers excellent aesthetic outcomes, but nipple-areolar complex (NAC) necrosis remains a major complication. Although arterial insufficiency has been emphasized, venous injury may also play a critical role.</p><p><strong>Objectives: </strong>The aim of this study was to characterize NAC venous anatomy and determine whether venous injury contributes to clinically significant NAC necrosis after NSM.</p><p><strong>Methods: </strong>The authors performed a cadaveric study of superficial periareolar venous anatomy and a prospective clinical cohort study of 123 breasts undergoing NSM with immediate IBBR. Cutaneous NAC veins were visualized using near-infrared (NIR) imaging, and venous injury was quantified as vein branch loss (VBL). We evaluated predictors of clinically significant NAC necrosis and developed a prediction model compared with intraoperative indocyanine green angiography (ICGA) in 32 breasts.</p><p><strong>Results: </strong>Cadaveric dissection demonstrated a polygonal venous network adjacent to the areolar margin. In the clinical cohort, significant NAC necrosis occurred in 19 of 123 breasts (15.4%). On univariate analysis, higher VBL, greater mastectomy weight, higher BMI, and diabetes were associated with NAC necrosis (P < .05). Multivariable analysis demonstrated that the effect of VBL increased with mastectomy weight. The final model showed strong discrimination (area under the receiver operating characteristic 0.902; 95% CI, 0.82-0.98) and identified a low-risk subset among breasts with poor ICGA perfusion in which no significant NAC necrosis occurred.</p><p><strong>Conclusions: </strong>Venous integrity is a key determinant of NAC viability after NSM. NIR-based vein analysis enables quantitative assessment of venous injury and may complement ICGA in perioperative risk stratification and surgical planning.</p><p><strong>Level of evidence: 4 (risk): </strong>For image description, please refer to the figure legend and surrounding text.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"1127-1136"},"PeriodicalIF":4.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}