Reduction mammoplasty with nipple aureola complex free graft [Mastoplastica riduttiva con innesto libero del complesso areola-capezzolo]

The authors report their surgical experience concerning cases of severe mammary hypertrophy and gigantomastia. They focus in particular on the technique of reduction mammoplasty using a free graft of the nipple aureola complex, as described by Conway in 1952, associated in the majority of cases with use of a dermoglandular filling flap for the upper pole. The efficacy of this technique is demonstrated in subjects with special characteristics using a long and careful follow-up study. This technique was used to allay fears of the risk of nipple-aureola complex necrosis, in an attempt to preserve nipple extroflexion by salvaging part of the intrinsic muscular component. Methods. All operations were performed at the 2nd University of Naples. The authors used the above technique on five patients, observing the results obtained until 24 months after surgery. The patients were randomly selected from a group of women aged between 29 and 58 years old who presented an average distance of the nipple-aureola complex from the jugular arch of 36 cm (range 34-39 cm). Results. The results demonstrate that, seventy years after it was first used, in spite of modifications introduced in some cases entailing the use of a dermoglandular flap to fill the upper pole which is normally empty in these patients, this technique not only allows the complete morphovolumetric restoration of a severely hypertrophic breast, but also achieves excellent cosmetic results. It is hampered by a number of drawbacks, including the partial loss of feeling in the nipple-aureola complex and the interruption of the glandular ducts following resection. Conclusions. The authors confirm the value and topicality of the technique and justify its use under very specific conditions.