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Assessment of long-term pigmentation changes in the nipple-areolar complex following the use of free nipple grafts
Pooja Humar, B.S., Elizabeth Bailey, MD, MEd, MSHP, Michael Gimbel, MD, Carolyn De La Cruz, MD
University of Pittsburgh School of Medicine
2022-01-15
Presenter: Pooja Humar
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The work in this project represents original work of the authors involved.
Director Name: Dr. Michael Gimbel
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction: In patients with profound macromastia, using free nipple grafts (FNG) during breast reduction can decrease nipple areolar complex (NAC) hypoperfusion and subsequent loss. One drawback of this approach is hypopigmentation of the NAC. This study seeks to quantify long-term pigmentation changes in the NAC following reduction mammoplasty with FNG.
Methods: We conducted a retrospective review of patients who underwent reduction mammoplasty with FNG between 2000-2020 at our institution. Pre-operative, early, and late post-operative images were analyzed using NIH ImageJ software.
Results: Of the 151 patients identified, 39 patients (25.8%) had complete images from the defined time-points. Mean patient age was 45yrs. Average follow-up for early post-operative images was 0.2yrs ± 0.2 and 1.0yrs ± 0.9 for late post-operative images. Early image analysis revealed 28.1% ± 20.1% of the NAC surface area had hypopigmentation which decreased to 9.2% ± 9.7% of the NAC on late post-operative imaging (p<0.001). All patients in the cohort were found to have some degree of hypopigmentation at the early post-operative period. Of these patients, 80.8% showed re-pigmentation from early to late post-operative, 6.4% showed increased hypopigmentation, and 12.8% saw no change. Among patients who saw late re-pigmentation, the mean increase was 25.1% ± 19.4% and there was an average of 69% ± 20.9% resolution of hypopigmentation.
Conclusion: While hypopigmentation of the NAC is common following FNG, many patients see late re-pigmentation with low residual hypopigmentation at 1 year. These findings may be useful for counseling FNG patients with early pigment changes in addition to guiding surgical decisions about breast reduction with FNG.
