The Blood Supply to the Nipple-Areola Complex . A Literature Review

Abstract

Introduction: This article presents a database review, which explain the blood supply to the nipple-areola complex (NAC). Objectives: Clarify the blood supply to the NAC. Materials and Methods: The sampling method that has been choosen for search in scientific database and textbooks, includes the next three criteria: the descriptions of the NAC s blood supply variety, the description of the blood sources and anatomic substantiation. Results: In clinical use the NAC vascularity was grouped in three systems: superficial medial, deep central and mixed lateral. The medial system shows maximal anatomic stability. It consists of the superficial branches of a.thoracica interna and a more superficial venous system, which flows into the v.thoracica interna system. The central system includes the a. thoracoacromialis and aa. Intercostales perforators. They support the medial and lateral vascular systems by anastomosing with them on some levels. this system is the main NAC s blood supply system. The lateral system consist of vessels which variably originate from a.thoracica lateralis, a.axillaris and a. thoracoacromialis. In 14% cases there is only one superficial a.thoracica superficialis in this zone, which goes to the NAC through the subdermal fatty layer. Some of another deep vessels go directly from deep to the NAC. Conclusion: During extensive resections the medial vascular system can be used for NAC preservation. Shouldn t be used only the central vascular system, because then the NAC’s necrosis risk is increased. This system can be used only as secondary option. The lateral system can be used for NAC preservation only if the blood supply is confirmed. The medial vascular system underlies the thin superomedial NAC pedicle, but its safety requires additional analysis.