Duplex Study of the Nipple-Areola Complex Blood Supply in the Female Breast.

Background: Although breast blood supply comes from the internal mammary, lateral thoracic, and intercostal artery perforators, the nipple-areola complex (NAC) blood supply was usually depicted as a direct continuation of those vessels rather than a true description based on anatomical research. Studies focusing on NAC vascularity are few in number, done on a limited number of subject based on microdissection, computed tomography, or MRI. The results are inconsistent and may be perplexing. Hence, the need for studies on a large number of living subject is still warranted. Because duplex proved efficient at detecting perforators, we used it to assess NAC vascularity.

Objectives: In vivo delineation of NAC blood supply by comparing this to the nipple-to-suprasternal notch (N-SN) distance and individual variation between both sides.

Methods: Female subject presenting to the Breast Imaging Unit of the institute (229 subject; 458 breasts, BIRADS I and II) were assessed by duplex for the presence of significant NAC blood supply (≥1 mm), regarding their number, source vessel, perforator level, relation to N-SN distance, and similarity between both sides.

Results: The third and fourth internal mammary artery (IMA) perforators accounted for 54.8% and 31.3%, respectively. The second IMA, lateral thoracic artery, and direct axillary branch were found in 9.2%, 3.3%, and 1.3%, respectively. The longer the N-SN distance is, the lower the supplying perforator. NAC vascularity was symmetric in 143 subject (62.4%) and asymmetric in 86 subject (37.5%).

Conclusions: The third and fourth internal mammary perforators are the main source of NAC blood supply. Right and left sides' asymmetry is not uncommon. Finally, the longer the N-SN distance is, the lower the perforator level is anticipated.

Level of evidence 1 diagnostic: