Sensory preservation in reduction mammoplasty using the nipple-areola complex-carrying pedicle technique for gigantomastia: A systematic review and meta-analysis

F. Bonomi; Y. Harder; G. Treglia; E. Limido; M. De Monti; C. Parodi

JPRAS Open (Mar 2025)

Sensory preservation in reduction mammoplasty using the nipple-areola complex-carrying pedicle technique for gigantomastia: A systematic review and meta-analysis

F. Bonomi,
Y. Harder,
G. Treglia,
E. Limido,
M. De Monti,
C. Parodi

Affiliations

F. Bonomi: Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Institute for Clinical and Experimental Surgery, Saarland University, Homburg/Saar, Germany
Y. Harder: Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
G. Treglia: Division of Medical Education and Research, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
E. Limido: Institute for Clinical and Experimental Surgery, Saarland University, Homburg/Saar, Germany; Department of Surgery, Ospedale Beata Vergine di Mendrisio, Ente Ospedaliero Cantonale (EOC), Mendrisio, Switzerland
M. De Monti: Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Department of Surgery, Ospedale Beata Vergine di Mendrisio, Ente Ospedaliero Cantonale (EOC), Mendrisio, Switzerland
C. Parodi: Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Corresponding author.

Journal volume & issue: Vol. 43
pp. 153 – 163

Abstract

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Background: Gigantomastia is a disabling condition characterized by excess breast tissue. Historically, free nipple graft (FNG) has been preferred, prioritizing the nipple-areola complex (NAC) vascularity. The NAC-carrying pedicle technique, which is most commonly used in case of hypertrophy of the breast, has been suggested as a viable alternative for gigantomastia according to recent evidence, with reduced rates of NAC necrosis and improved outcomes. Nevertheless, a detailed outcome evaluation of the technique in terms of sensory preservation is currently lacking. Therefore, this systematic review and meta-analysis aimed to assess the risk of sensory loss associated with the NAC-carrying pedicle technique in cases of gigantomastia. Methods: Following the PRISMA guidelines, a literature search identified studies reporting postoperative sensitivity with the NAC-carrying pedicle technique in resections exceeding 1000 g of adipo-glandular tissue. Then, a proportion meta-analysis was conducted to assess the pooled rate of sensation loss through the NAC-carrying pedicle technique. Results: Seventeen studies (843 patients, 1685 breasts) met the inclusion criteria. The meta-analysis revealed an exceptionally low risk of sensory loss with the NAC-carrying pedicle technique (1.3%; 95% confidence interval: 0.7-2.0), without significant statistical heterogeneity. Conclusion: This study provides the first comprehensive evaluation of sensory preservation with the NAC-carrying pedicle technique in gigantomastia. The NAC-carrying pedicle technique emerges as the first choice, offering safety and favorable functional outcomes. Surgical caution remains crucial with the option to switch to FNG as required, ensuring patient safety and procedure success. Further research on the impact of different NAC-carrying pedicle techniques on sensory preservation is warranted.

Published in JPRAS Open

ISSN: 2352-5878 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/jpras-open/

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