Aesthetic Plastic Surgery

, Volume 43, Issue 6, pp 1506–1514 | Cite as

Nipple–Areola Complex Ischemia or Necrosis in Freestyle Perforator Flap Reduction Mammoplasty Operations

  • Nader ElmelegyEmail author
  • Tarek Shokr
  • Mamdouh Osama
Original Article Breast Surgery



Necrosis of the nipple–areolar complex (NAC) is one of the most devastating complications of reduction mammoplasty. A variable, asymmetrical pattern of blood supply from the main sources was found in the same individual. To solve this problem, we present a method to be sure that the blood supply to the NAC is contained within the designed pedicle during reduction mammoplasty. This is done using the colored duplex scan and handheld Doppler to perform freestyle perforator flap reduction mammoplasty.


This is a prospective randomized study that has been performed on 105 patients in the period between January 2014 and 2019 at the Plastic and Reconstructive Surgery Department, Tanta University Hospitals. Freestyle perforator flaps were performed for all cases after perforator detection using handheld Doppler and confirmed by colored duplex scan.


The procedure was performed as freestyle on medial perforators in 35 (33.3%) cases, on lateral perforators in 20 (19%) cases, on combined medial and lateral perforators, as a bipedicle in 30 (28.7%) cases, on upper pole perforators in 12 (11.4%) cases, and on lower pole perforators in 8 (7.6%) cases.


The use of handheld Doppler and the confirmation by duplex scan are mandatory to decrease the incidence of NAC necrosis or ischemia.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors


Breast reduction Freestyle Perforator flap Nipple necrosis Nipple ischemia 




Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest to disclose.

Ethical Approval

All the procedures performed in this study that involved human participants were in accordance with the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or ethical standards. Accepted principles of ethical and professional conduct have been followed. This article was approved by Tanta University’s Ethical Committee (2013/12/21).

Informed Consent

Informed consent was obtained from all individual participants included in the study, and additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Supplementary material

266_2019_1511_MOESM1_ESM.avi (14.5 mb)
Supplementary material 1 (AVI 14817 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Department of Plastic Surgery, Faculty of MedicineTanta UniversityTantaEgypt

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