ncs 41 ngoại khoa(CTCHVTH) Tạ Thị Hồng Thuý - CHECK BREASTS MASTOPEXY REDUCTION.pptx

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1. 1 CHARACTERISTIC S OF THE MAIN BLOOD SUPPLY FOR THE NIPPLE- AREOLA COMPLEX BY MULTI-SLICE COMPUTED TOMOGRAPHY IN BREAST REDUCTION Speaker: Ta Thi Hong Thuy Supervisor: Pham Thi Viet Dung, MD PhD

2. : INTRODUCTION Grade 1 Normal Grade 2 Grade 3 Grade 3 Grade 2 Grade 1 Grade 4 Patients with grade 3 and 4 breast enlargement and grade 3 breast enlargement ptosis are always a challenge for plastic surgeons.

3. INTRODUCTION 3 Reduction surgery for giant breasts still uses the classic Thorex technique: nipple areola complex grafting many complications including areola morphology deformation, nipple loss, and loss of function. Therefore, it is important for surgeons to find a flap that carries the nipple areola complex with nourishing blood vessels. Therefore, studying the source of blood vessels supplying blood to the nipple areola is necessary

4. OBJECTIVE To identify the main arterial sources of blood supply to the nipple - areola complex (NAC), which is appl icabl e to very large hypertrophic breast reduction surgery.

5. METHODS

6. METHODS: Perform surgery Before surgery Classification of hypertrophic breast by MSCT Classification of potosis

7. METHODS: Perform surgery INDEX REFERENCE INDEX Sternal notch distance 17-18 cm Sternum –Nipple distance 15-16cm Nipple-IMF distance 5-6cm Nipple inframammary fold Areola diameter 2,5-5cm Internipple distance 18-20cm MEASURING INDICATORS

8. METHODS: Perform surgery Breast blood supply characteristics MSCT images: Characteristics of vascular branches from the external and internal mammary arteries to the NAC Quantity and starting position through the intercostal space for the internal breast. Artery diameter The depth of the artery relative to the skin Directions to NAC

9. METHODS: Perform surgery Lateral thoracic artery Internal mammary artery Superior pedicle Superior pedicle Lateral pedicle Superomedial pedicle Inferior lateral pedicle inferior medial pedicle Choose the type of flap that carries the vascular axis from the external and internal mammary arteries Lateral pedicle Superior pedicle Superomedial pedicle inferior medial pedicle

10. METHODS: Perform surgery Type of pedical and skin incision design Superiomedial pedicle Right, Superior pedicle Left Superiomedial pedicle both side

11. METHODS: Perform surgery NAC survival after surgery (Post- Op)

12. RESULTS & DISCUSSION AGE DISTRIBUTION AGE MEAN: 30,27 Time of disease onset: Adolescent: 43,33% After maternity: 56,67% N. N. Hà 33,1 N.Đ.Hung . 29,5 Mandrekas 33,1

13. RESULTS & DISCUSSION CLASSIFICATION OF HYPERTROPHIC BREAST Average volume Right: 1263,57ml (664-2412) Average volume Left: : 1214,93ml (529-2216) 35/60 (58,33% 15/60 (25%) 10/60 (16,67%) The rate of mammary gland enlargement is Giant N.T.T. Huyen 11,8% N. D. Hung 6,5%

14. RESULTS & DISCUSSION CLASSIFICATION OF POTOSIS BREAST Sternum –Nipple distance: 28,4cm (21-36cm)   GRADE 1 GRADE 2 GRADE 3 n % n % n % Right Breast (N=30) 3 10 2 7 90 Left Breast (N=30) 3 20 2 7 90 Tổng (N=60) 6 1 54 90

15. RESULTS & DISCUSSION Characteristics of the lateral thoracic artery and internal mammary artery supplying blood to the Nipple-Areola complex in MSCT 9/30 patients (33.3%) had different vascular branch directions on both sides of the breast into the NAC 100% of internal mammary arteries branch into the NAC 36/60 (60%) external mammary arteries branch into the NAC

16. RESULTS & DISCUSSION Characteristics of the lateral thoracic artery supplying blood to the Nipple-Areola complex in MSCT 36/60 breasts have branch arteries entering the NAC: - Distance to NAC: 8.14 cm. - 100% of the vascular branches enter the mammary gland before going close to the nipple areola complex. - The location of the branch from the lateral thoracic artery entering the NAC from superior is 10/36 breasts, the lateral location is 15/36 breasts, the inferior is 11/36 breasts.

17. RESULTS & DISCUSSION Characteristics of the internal mammary artery supplying blood to the Nipple-Areola complex in MSCT 100% of internal mammary arteries branch into the areola complex Distance to nipple areola complex 5.78 cm - 34/ 69 vascular branches go close to the nipple areola complex, 100% of the vascular endings penetrate close to the skin. The mean meridian of the artery at the base is 1.86 mm one branch two branches

18. KẾT QUẢ-BÀN LUẬN BN Pham Thị L. Characteristics of the internal mammary artery in MSCT

19. RESULTS & DISCUSSION Characteristics of the lateral thoracic artery and internal mammary artery  SELECTING THE BLOOD SUPPLY ARTERY FOR THE NAC I nternal mammary artery - Characteristics of d istance to nipple areola complex, the vascular endings penetrate close to the skin. Advantages of moving the flap carring NAC  The absolute choice is the axial flap carrying NAC from the internal mammary artery (100%)

20. RESULTS & DISCUSSION Characteristics of the flap carrying the NAC from the internal mammary artery branch Superomedial flap both side Superior flap Left Superomedial flap Right Inferior medial pedicle Tyoe of flap Member (n=60_ Percent (%) Superomedial flap 4 7 7 8,33 % Superior flap 6 1 % Inferior medial pedicle 7 1 1 , 67 % 6 100%

21. RESULTS & DISCUSSION SURGICAL RESULTS Đánh giá sức sống QNV sau phẫu thuật NC chúng tôi 57/60 vú ( 95% ) sức sống QNV tốt . 2/60 vú ( 3,33% ) hoại tử QNV 1 phần . 0% hoại tử toàn bộ . Chủ yếu do ứ tĩnh mạch NĐH ( trục ngục ngoài ) 90% QNV sức sống tốt . 8,1% hoại tử 1 phần . Nahabedian ( Cuống trong kinh điển ) 2% QNV hoại tử 57/60 breasts (95%) have good NAC survival. 2/60 breasts (3.33%) had partial NAC necrosis. 0% total necrosis. The main cause is venous stasis N.D.Hung 8.1% had partial necrosis. Other 6-10%

22. - MSCT imaging can identify the blood supply from the internal and external mammary arteries, determining the dominant vascular source for NAC. - S elect ing 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. . CONCLUSIONS

23. Patient: Vo Cam C. , 22 years old. Superomedial pedical both side Before Post-op 2 weeks NAC+++

24. The flap carries the NAC RIGHT: width/ lengh =1/4 LEFT: width/ lengh =1/4

25. THANK YOU FOR YOUR ATTENTION !