Duplex Study of the Nipple–Areola Complex Blood Supply in the Female Breast

Abstract Background Although breast blood supply comes from the internal mammary, lateral thoracic, and intercostal artery perforators, the nipple–areola complex (NAC) blood supply was usually depicted as a direct continuation of those vessels rather than a true description based on anatomical research. Studies focusing on NAC vascularity are few in number, done on a limited number of subject based on microdissection, computed tomography, or MRI. The results are inconsistent and may be perplexing. Hence, the need for studies on a large number of living subject is still warranted. Because duplex proved efficient at detecting perforators, we used it to assess NAC vascularity. Objectives In vivo delineation of NAC blood supply by comparing this to the nipple-to-suprasternal notch (N-SN) distance and individual variation between both sides. Methods Female subject presenting to the Breast Imaging Unit of the institute (229 subject; 458 breasts, BIRADS I and II) were assessed by duplex for the presence of significant NAC blood supply (≥1 mm), regarding their number, source vessel, perforator level, relation to N-SN distance, and similarity between both sides. Results The third and fourth internal mammary artery (IMA) perforators accounted for 54.8% and 31.3%, respectively. The second IMA, lateral thoracic artery, and direct axillary branch were found in 9.2%, 3.3%, and 1.3%, respectively. The longer the N-SN distance is, the lower the supplying perforator. NAC vascularity was symmetric in 143 subject (62.4%) and asymmetric in 86 subject (37.5%). Conclusions The third and fourth internal mammary perforators are the main source of NAC blood supply. Right and left sides’ asymmetry is not uncommon. Finally, the longer the N-SN distance is, the lower the perforator level is anticipated. Level of Evidence: 1 (Diagnostic)