Preoperative composite vascular mapping in superomedial therapeutic mammoplasty for patients with more than 35 CM sternal notch to nipple distance.

BACKGROUND: The superomedial pedicle (SMP) technique of therapeutic mammoplasty (TM) is a well-established option for breast cancer treatment. However, there are concerns regarding the reliability of its vascular supply, especially at sternal notch to nipple (SN-N) distances > 35 cm. We believe composite vascular mapping will have better outcomes than traditional anatomical landmark techniques in the SMP approach at SN-N distances > 35 cm. METHODS: A retrospective cohort study compared 121 breast cancer patients (62 preoperative composite vascular mapping, 59 no mapping) who underwent the SMP technique with an SN-N distance > 35 cm. Outcomes included operative time, nipple areola complex (NAC) viability, postoperative complications, and patient satisfaction with breasts, outcomes, and nipples. RESULTS: The groups differed statistically only in that the mapping group was older (58.41 ± 7.69 vs. 54.32 ± 8.10 years; p = 0.007). Mean operative time was shorter with mapping (86.16 ± 4.24 vs. 101.2 ± 6.11; p < 0.001). Composite vascular mapping resulted in increased NAC viability (100% vs. 91.5%; p = 0.025) and wound healing (0% vs. 8.5%; p = 0.025), along with decreased postoperative breast pain (2.95 ± 0.22 vs. 2.71 ± 0.46; p < 0.001). Satisfaction with nipples was significantly higher across all categories in the mapping group, including nipple position (p = 0.028), alignment (p = 0.011), shape (p = 0.038), appearance (p = 0.049), and sensation (p = 0.001). CONCLUSION: Composite vascular mapping had comparable or superior outcomes to the non-mapping group, increasing the safety and success of the SMP technique at SN-N distance > 35 cm.