Freestyle Perforator Flap Based Reduction Mammoplasty According to Dominant Perforator Determined by Handheld Doppler US (Benha University Study)

Background: Breast hypertrophy may cause physical and psychological distress, and reduction mammoplasty is the treatment of choice. However, variations in vascular anatomy predispose to Nipple–Areola Complex (NAC) complications as necrosis. NAC necrosis is one of the most devastating complications of reduction mammoplasty especially in large breast volume. Preoperative handheld Doppler can identify dominant perforators and optimize the pedicle selection to perform freestyle perforator flap based reduction mammoplasty. Objectives: This study aimed to evaluate the efficacy and safety of freestyle perforator flap based reduction mammoplasty guided by preoperative handheld Doppler mapping of the dominant perforator and its effect on complications rate. Subjective & Methods: This prospective, single-blinded trial study, sixty women complaining of hypertrophied breast were included. Patients were recruited from plastic, reconstructive outpatient clinic in Benha University hospital in a period from December 2023 – august 2025. All women underwent inverted-T reductions after preoperative doppler identification of dominant perforators. Results: The distance between suprasternal notch and NAC was ranged from en 33.5 and 46.5 cm (mean ± SD 39.2 ± 3.63. The weight of the resected breast tissue ranged from 400 to 1200 gm per side with a mean value of 719 gm. A single perforator was identified in 36 cases (60%) and two in 24 cases (40%). All NACs remained viable; venous congestion occurred in 6 patients (10%), with no ischemia or necrosis. NAC sensation was preserved at high or very high levels in 40 patients (66.6%). Overall, 48 patients (80%) were satisfied, including 32 (53.3%) who were very satisfied. Conclusions: Handheld Doppler–guided identification of dominant perforators allows individualized pedicle choice in large breast reduction mammoplasty, resulting in high satisfaction, preserved NAC viability, favorable sensory outcomes, and acceptable complication rates.