Nipple-areolar perfusion and reduction mammaplasty: correlation of laser Doppler readings with surgical complications

Clinical assessment of nipple-areolar perfusion by color, capillary refill, and temperature during and after reduction mammaplasty is generally satisfactory. However, the estimation of vascular perfusion in patients with very large breasts or dark-skinned women is difficult. If marginal perfusion of the nipple-areolar areas is undetected, necrosis is likely. To this point, no studies have tested the ability of the laser Doppler perfusion monitor to give absolute alarm values that would suggest marginal perfusion in the nipple-areola following reduction mammaplasty. We therefore completed a prospective study of areolar perfusion during surgery and for up to 24 hours following reduction mammaplasty. Fifty-four patients were studied and data collected from 104 breasts. Laser Doppler perfusion was measured with a LASERFLO BPM2 Blood Perfusion Monitor (Vasamedics, St. Paul, Minn.). Perfusion values were recorded for each breast following anesthesia but prior to the incisions, at the end of surgery, and every 2 hours for 24 hours. Patients were divided into three groups according to their follow-up results: no complications (92 breasts), minor complications (9 breasts), and patients with tissue necrosis (3 breasts). The no complications group had a perfusion of 4.8 ml/min/100 gm following the reduction procedure, while the minor complications and tissue necrosis groups had average perfusions of 1.4 and 0.8, respectively, immediately after incision closure. The average tissue removed from each group was 811, 1171, and 2118 gm for the no complications, minor complications, and tissue necrosis groups, respectively. The results from this study suggest that a laser Doppler perfusion monitor could prove useful for monitoring areolar perfusion following reduction mammaplasty, especially in patients with extremely large breasts and/or dark skin. Our studies have shown that laser Doppler perfusion values that consistently are in the range of 1.0 to 2.0 ml/min/100 gm indicate marginal perfusion, and the recovery of these patients should be followed closely. Furthermore, patients with consistent perfusion values equal to or less than 1.0 coupled with other clinical signs of low perfusion should be considered for suture removal and/or free nipple graft.