The Safety of Operating on Breasts With a History of Prior Reduction Mammoplasty: Dynamic Magnetic Resonance Imaging Analysis of Angiogenesis

Background Vascularity of the nipple-areolar complex (NAC) is altered after reduction mammoplasty, which increases complications risks after repeat reduction or nipple-sparing mastectomy. Objectives To evaluate angiogenesis of the NAC via serial analysis of breast magnetic resonance images (MRIs). Methods Breast MRIs after reduction mammoplasty were analyzed for 35 patients (39 breasts) using three-dimensional reconstructions of maximal intensity projection images. All veins terminating at the NAC were classified as internal mammary, anterior intercostal, or lateral thoracic in origin. The vein with the largest diameter was considered the dominant vein. Images were classified based on the time since reduction: <6 months, 6-12 months, 12-24 months, >2 years. Results The average number of veins increased over time: 1.17 (<6 months), 1.56 (6–12 months), 1.64 (12–24 months), 1.73 (>2 years). Within 6 months, the pedicle was the only vein. Veins from other sources began to appear at 6–12 months. In most patients, at least two veins were available after 1 year. After 1 year, the internal mammary vein was the most common dominant vein regardless of the pedicle used. Conclusions In the initial 6 months after reduction mammoplasty, the pedicle is the only source of venous drainage; however, additional sources are available after 1 year. The internal thoracic vein was the dominant in most patients. Thus, repeat reduction mammoplasty or nipple-sparing mastectomy should be performed ≥1 year following the initial procedure. After 1 year, the superior or superomedial pedicle may represent the safest option when the previous pedicle is unknown.