Deskinning the pedicle during breast reduction is safe

In breast reduction surgery, deskinning the pedicle yields a comparable rate of nipple-areola complex (NAC) necrosis as de-epithelialization of the NAC, a new study has found.

The study included 142 patients who had a median resection weight of 287 g per breast. All procedures were performed by one surgeon, and all participants underwent deskinning of the superomedial pedicle. The study outcome was the rate of partial or complete NAC necrosis, defined as full-thickness skin loss. All data were obtained and reviewed retrospectively.

Over a median follow-up of 677 days, researchers found no case of complete NAC necrosis, though two patients did experience partial necrosis. One had a history of deep venous thrombosis and was on thromboprophylaxis, while the other was healthy.

In a subsequent systematic review of nine studies including 680 patients, researchers found a 1.5-percent rate of NAC necrosis. Out of the 10 cases, three were complete, one was partial, and the remaining were unclassified. These patients underwent breast reduction with de-epithelialization of the superior or superomedial pedicle.

Ten patients developed unilateral haematomas at a median of 5.9 hours after the primary surgery. All haematomas were classified as minor. In addition, four cases of deep surgical site infections were reported, along with seven superficial surgical site infections. All were treated with antibiotics.

The most common minor complication was delayed wound healing, observed in 34 participants (24 percent). All issues were resolved with conservative treatment. There were no postoperative seromas, though two patients developed fat necrosis.