Intercostothelial circulation: nipple survival in reduction mammaplasty in the absence of a dermal pedicle.

In recent years, there has been considerable discussion and controversy regarding the major vascular supply to the nipple. We report our experience with the use of a long, narrow, glandular pedicle based on the pectoralis major muscle in reduction mammaplasty in 29 breasts in 15 patients. The vascular supply to the nipple-areolar complex in this type of flap is derived from intercostal perforating vessels. Although it may make some contribution, a dermal bridge or flap is not required for the survival of these structures.