BACKGROUND

Large volume breast reductions are at increased risk of nipple ischemia and necrosis due to tenuous blood supply of long pedicles. We adapted incisional negative pressure wound therapy to augment nipple survival in such patients undergoing mammaplasty by inferior pedicle technique.

METHODS

Patients with nipple-to-inframammary fold distance >14 cm were informed of increased risk of requiring free nipple graft. All patients underwent inferior pedicle technique with Wise pattern skin incision. Once incisions were closed and the nipple-areolar complex was inset, the complex was assessed for vascularity. In 12 cases there was evidence of compromised arterial inflow or venous outflow. For these patients, incisional negative pressure wound therapy was applied to the bilateral nipple-areolar complexes for 5-7 days.

RESULTS

None of the 12 patients (24 breasts) in this series experienced nipple-areolar complex ischemia or necrosis. Only 2 patients experienced delayed wound healing which was successfully managed by local wound care.

CONCLUSIONS

This study demonstrates the utility of negative pressure wound therapy in nipple survival for at-risk patients. We believe it augments healing by allowing improved micro-circulation.

LEVEL OF EVIDENCE IV

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