Perfusion control of the nipple-areola complex in reduction plasty for gigantomastia using indocyanine green: A prospective observational study.

Abstract

Reduction mammaplasty in patients with severe macromastia poses technical challenges. In cases involving large resection volumes and long distances between the sternal notch and nipple, the risk of postoperative perfusion disturbance in the nipple-areola complex (NAC) is significantly increased. Indocyanine green (ICG) angiography has proven helpful in numerous clinical applications and can support the objective assessment of tissue perfusion which is particularly helpful in situations where vascularization is compromised, such as extreme volume reductions. We investigated whether ICG angiography can reliably detect areas of hypoperfusion, help prevent postoperative NAC necrosis and serve as a reliable decision-making tool. This prospective observational study was conducted between August 2023 and May 2025. All procedures were performed using the Double-Unit Superomedio-Central Pedicle technique. The study included adult patients with a sternal notch (SN)-to-nipple distance >35 cm. Subsequently, ICG angiography was employed to assess real-time perfusion of the NAC. The analysis included a total of 21 patients (42 breasts). The mean age of these patients was 46.3 ± 12.7 years (range 26-70 years). The mean body mass index was 31.6 ± 5.9 kg/m². The average SN-NAC distance was 40.4 ± 4.1 cm on the right and 39.6 ± 3.7 cm on the left. In this patient cohort, no necrosis of the NAC occurred, even in cases involving breasts with SN-NAC distances exceeding 50 cm and high resection weights. Intraoperative ICG fluorescence angiography represents a promising tool to support surgical decision-making in reduction mammaplasty.