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Nipple-Sparing Gigantomastia Breast Reduction: A Systematic Review
Ian Zelko, DO
Anthony Deleonibus, MD
Daniel Bahat, MD
Vikas Kotha, MD
Sarah, Bishop, MD
Cleveland Clinic
2022-01-15
Presenter: Ian Zelko, DO
Affidavit:
I attest to the above
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
There remains an unclear definition of the term "gigantomastia," with many studies using different parameters and measurements. Currently, the operative management and patient education for gigantomastia is outdated. The historical teaching that a free nipple graft is necessary in elongated pedicles in order to avoid nipple necrosis may not be factual. The principal goal of our review aims to determine the safety of nipple-sparing breast reductions on large ptotic breasts via complication rate analysis.
The systematic review followed the PRISMA guidelines of conduct for systematic review and meta-analysis. In October 2021, PubMed was used to search the US National Library of Medicine database. Rayyan Intelligent Systematic Review aided in screening studies by title then abstract. If inclusion criteria were met, the entire article was reviewed.
Twenty-two articles satisfied the inclusion and exclusion criteria. The study was comprised of 1689 total patients with a mean BMI of 32.9 (3.4). Mean mid-clavicle to nipple distance and resection weight per breast was 39cm (3.8) and 1423.8g (268.9), respectively. A Wise pattern was preferred in 77.3% of the studies, with an inferior (45.5%) and superomedial (45.5%) pedicle used most commonly. Complete NAC necrosis (1.7%) was found in 4 studies, while partial (5.9%) was observed in 11. More common complications included delayed wound healing (17.4%), surgical site infection (14.3%), seroma (10.5%), scar hypertrophy (9.9%), and wound dehiscence (9.2%).
Nipple-sparing breast reduction surgery can be safely performed on hypertrophic and severely ptotic breasts with comparable complication rates as those performed on smaller breasts.
