ÁP DỤNG CHỤP CẮT LỚP VI TÍNH ĐA DÃY TRONG VIỆC LỰA CHỌN CUỐNG MẠCH CẤP MÁU MANG PHỨC HỢP QUẦNG NÚM VÚ TRONG PHẪU THUẬT THU GỌN VÚ

Abstract

Objective: Aims to identify the main arterial sources of blood supply to the nipple-areola complex (NAC), which is applicable to very large hypertrophic breast reduction surgery, in order to minimize the risk of NAC complex necrosis. Methods: Describe a cross-sectional, uncontrolled clinical case series to evaluate the most accurate blood supply to the NAC based on angiography for all patients diagnosed with excessive breast enlargement requiring surgery. Results: 28 patients with grade 3 ptosis underwent multi-slice computerized tomography (MSCT) scan of both breasts to determine the dominant blood supply to the nipple areola. Of the blood supplies to the breast, the internal mammary artery predominates in 56/56 breasts (100%), the external thoracic artery predominates in 19/56 breasts (33,93%), and the intercostal artery in 8/56 breasts (14,3%). MSCT measures a minimum breast volume of 1000ml and the maximum of 2412ml. Based on the MSCT scan results, the axial flap design carrying the QNV complex has a dominant branch entirely from the internal mammary artery: superior medial pedicle in 43/56 (76,79%), superior pedicle in 9/56 breasts (16,07%) and medial pedicle in 4/56 breasts (7,14%). None of the breasts showed signs of nipple-areola necrosis after surgery, and only 2 NAC had mild hypotrophy. Conclusion: Preoperative breast MSCT imaging is helpful in selecting the type of pedicle that supplies blood to the NAC, and minimizes the risk of NAC necrosis during breast reduction surgery in cases of significant hypertrophy and severe grades of ptosis.