Prediction of nipple viability following reduction mammoplasty using laser Doppler flowmetry.

The assessment of viability of a pedicled nipple-areola complex after reduction mammoplasty frequently may be frustrating due to equivocal clinical signs of adequate blood flow. Although conversion to a composite graft is always a safe option, the aesthetic result may be inferior. An objective monitor might be beneficial to maximize the surgical outcome while minimizing the risk of nipple necrosis. Laser Doppler flowmetry provides a safe, simple, and noninvasive objective monitor that allows continuous intra-operative or postoperative evaluation of nipple perfusion. An evaluation of 31 nipples in 16 patients undergoing breast reduction based solely on the surgeon's judgment would have resulted in 9 false positive or negative results as compared with 3 using the laser Doppler. Four nipples that may otherwise have been converted to free grafts were instead preserved. However, conclusions from this data limit the laser Doppler as a valuable supplement, but not a replacement, for experienced clinical acumen.