Humayun Ayub Khan1, Ardeshir Bayat. 1. Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Preston, United Kingdom.
Abstract
BACKGROUND: An important part of preoperative assessment in breast reduction surgery is to locate the site of the nipple-areola complex for the newly structured breast. Inappropriate location is difficult to correct secondarily. Traditional methods of nipple localization taught and practiced suggest the nipple to be located anterior to the inframammary fold. Trying to project this point on the anterior surface of the breast requires either large calipers or feeling the posteriorly placed finger on the anterior surface of a large breast. This certainly introduces some subjectivity to the calculation. OBJECTIVES: To introduce an easy and accurate method of nipple localization to reduce the learning curve for trainee surgeons. METHODS: Aesthetic placement of the nipples is at the lower angles of an equilateral or a short isosceles triangle on the chest with its apex at the sternal angle. This triangle can be thought of as two right-angled triangles with their Y-axis on the median plane. The base and vertical limb are measured, and the hypotenuse is calculated. The location of the lower angle is marked on the anterior surface of the breast and represents the new position of the nipple. RESULTS: Forty patients had nipple localization performed in the above-described manner, with satisfactory placement of the nipple-areola complex. CONCLUSIONS: The above technique introduces some objective measurements to the localization of the nipple in breast reduction surgery. It is easy to practice, and infuses confidence in trainees marking their initial breast reductions.
BACKGROUND: An important part of preoperative assessment in breast reduction surgery is to locate the site of the nipple-areola complex for the newly structured breast. Inappropriate location is difficult to correct secondarily. Traditional methods of nipple localization taught and practiced suggest the nipple to be located anterior to the inframammary fold. Trying to project this point on the anterior surface of the breast requires either large calipers or feeling the posteriorly placed finger on the anterior surface of a large breast. This certainly introduces some subjectivity to the calculation. OBJECTIVES: To introduce an easy and accurate method of nipple localization to reduce the learning curve for trainee surgeons. METHODS: Aesthetic placement of the nipples is at the lower angles of an equilateral or a short isosceles triangle on the chest with its apex at the sternal angle. This triangle can be thought of as two right-angled triangles with their Y-axis on the median plane. The base and vertical limb are measured, and the hypotenuse is calculated. The location of the lower angle is marked on the anterior surface of the breast and represents the new position of the nipple. RESULTS: Forty patients had nipple localization performed in the above-described manner, with satisfactory placement of the nipple-areola complex. CONCLUSIONS: The above technique introduces some objective measurements to the localization of the nipple in breast reduction surgery. It is easy to practice, and infuses confidence in trainees marking their initial breast reductions.