Stirling Aaron D, Murray Conor P, Lee Mark A
Mark Lee Plastic Surgeon, St John of God Hospital, Subiaco, Perth, WA, 6008, Australia.
Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Dublin, Ireland.
Surg Radiol Anat. 2017 Oct;39(10):1127-1134. doi: 10.1007/s00276-017-1858-3. Epub 2017 Apr 21.
To investigate the blood supply to the nipple areola complex (NAC) on thoracic CT angiograms (CTA) to improve breast pedicle design in reduction mammoplasty.
In a single centre, CT scans of the thorax were retrospectively reviewed for suitability by a cardiothoracic radiologist. Suitable scans had one or both breasts visible in extended fields, with contrast enhancement of breast vasculature in a female patient. The arterial sources, intercostal space perforated, glandular/subcutaneous course, vessel entry point, and the presence of periareolar anastomoses were recorded for the NAC of each breast.
From 69 patients, 132 breasts were suitable for inclusion. The most reproducible arterial contribution to the NAC was perforating branches arising from the internal thoracic artery (ITA) (n = 108, 81.8%), followed by the long thoracic artery (LTA) (n = 31, 23.5%) and anterior intercostal arteries (AI) (n = 21, 15.9%). Blood supply was superficial versus deep in (n = 86, 79.6%) of ITA sources, (n = 28, 90.3%) of LTA sources, and 10 (47.6%) of AI sources. The most vascularly reliable breast pedicle would be asymmetrical in 7.9% as a conservative estimate.
We suggest that breast CT angiography can provide valuable information about NAC blood supply to aid customised pedicle design, especially in high-risk, large-volume breast reductions where the risk of vascular-dependent complications is the greatest and asymmetrical dominant vasculature may be present. Superficial ITA perforator supplies are predominant in a majority of women, followed by LTA- and AIA-based sources, respectively.
研究胸部CT血管造影（CTA）上乳头乳晕复合体（NAC）的血供情况，以改进缩乳术中的乳房蒂设计。
在单一中心，心胸放射科医生对胸部CT扫描进行回顾性评估是否合适。合适的扫描应在扩展视野中可见一侧或双侧乳房，且女性患者乳房血管有对比增强。记录每个乳房NAC的动脉来源、穿支的肋间间隙、腺体/皮下走行、血管进入点以及乳晕周围吻合支的存在情况。
69例患者中，132个乳房适合纳入研究。对NAC最可重复的动脉供血是胸廓内动脉（ITA）发出的穿支（n = 108，81.8%），其次是胸长动脉（LTA）（n = 31，23.5%）和肋间前动脉（AI）（n = 21，15.9%）。ITA来源的血供为浅部的占（n = 86，79.6%），LTA来源的占（n = 28，90.3%），AI来源的10个中有47.6%为浅部血供。保守估计，最具血管可靠性的乳房蒂不对称的情况占7.9%。
我们认为乳房CT血管造影可为NAC血供提供有价值的信息，以辅助定制蒂设计，特别是在血管依赖性并发症风险最大且可能存在不对称优势血管的高风险、大体积乳房缩小手术中。大多数女性中，浅部ITA穿支供血占主导，其次分别是基于LTA和AIA来源的供血。
