KỸ THUẬT MỚI TRONG PHẪU THUẬT THU GỌN VÚ THỂ TÍCH LỚN: SỬ DỤNG VẠT TRỤC MẠCH MANG PHỨC HỢP QUẦNG NÚM VÚ

Abstract

Objective: Severe and gigantomastic breast hypertrophy remains a challenge for plastic surgeons, particularly in preserving the nipple–areola complex (NAC). This study presents a novel technique using an axial flap carrying the NAC based on the dominant perforator, aiming to reduce the risks of necrosis, deformity, and loss of NAC function. Methods:  Thirty female patients with severe or gigantomastic breast hypertrophy underwent breast reduction between 2021 and 2024, using an axial flap carrying the NAC supplied by the lateral thoracic artery or internal mammary artery, preoperatively identified through multislice computed tomography (MSCT). Determining the dominant perforator supplying the NAC and perform T-scar breast reduction technique. Outcomes were assessed using standard breast reduction surgery criteria. Results: All 30 patients presented with severe ptosis, with breast volumes ranging from 1005 mL to 2412 mL. MSCT identified a dominant perforator from the IMA supplying the NAC in all 60 breasts (100%). Based on MSCT findings, the axial NAC flap was designed with a length-to-width ratio greater than 2:1: superomedial pedicle in 48 breasts (80%), superior pedicle in 11 breasts (18.33%), and medial pedicle in 1 breast (1.67%). Partial NAC necrosis occurred in 2 breasts (3.33%), both belonging to the superior pedicle group in gigantomastia patients. Good NAC sensation was restored 96.55%, with a satisfaction rate of 93.1%. Conclusion: Preoperative MSCT to identify the perforator supplying the NAC allows for precise selection of the axial NAC flap in large-volume and gigantomastic breast reductions. This advanced approach minimizes the risk of necrosis, deformity, and loss of NAC function, particularly in gigantomastia cases.