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American Association of Plastic Surgeons

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“Protect The Pigment”: Alternative To Free Nipple Grafting In Women Of Color With Gigantomastia
Jessica R. Cunning, BS, MBA, Arturo J. Rios-Diaz, MD, Olatomide Familusi, MD, Robyn B. Broach, PhD, Paris D. Butler, MD, MPH.
University of Pennsylvania, Philadelphia, PA, USA.

Purpose: For women with gigantomastia undergoing reduction mammoplasty, surgical technique profoundly impacts aesthetic outcome, particularly the nipple areolar complex (NAC). The historically recommended technique is breast amputation with free nipple grafting (BA-FNG). However, the frequent NAC hypopigmentation resulting from BA-FNG is undesirable and becomes strikingly more apparent in women with more native pigment. Expanding techniques of pedicled reductions (PR) could provide an opportunity to dramatically improve NAC aesthetic outcomes in women of color with gigantomastia.
Methods: Fifteen consecutive gigantomastia patients that underwent reduction mammoplasty in 2019 were identified. NAC aesthetic outcomes of BA-FNG and extended-PR were photographically compared postoperatively. A patient who underwent right BA-FNG and left extended-PR was assessed as an internal control.
Results: As depicted in the Figure, NAC pigmentation depended on surgical technique. The single patient that underwent BA-FNG experienced the classic NAC hypopigmentation (A). The 14 patients that underwent extended-PR had no nipple ischemia and retained their natural NAC pigment (B,C). The internal control demonstrated both NAC aesthetic outcomes (D), with extended-PR leading to a more desirable result.
Conclusion: Women of color with gigantomastia can safely undergo extended-PR and obtain superior NAC aesthetic outcomes, demonstrating one technique is not suitable for all. These findings suggest that it is time to revise antiquated treatment guidelines for gigantomastia to adjust for ethnic differences and ensure optimal results for all patients.


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