REDUCTION MAMMAPLASTY: FLAP VIABILITY, SURGICAL TECHNIQUES, AND COMPLICATION MANAGEMENT

Abstract

Objectives. To provide a comprehensive analysis of recent literature regarding flap viability in reduction mammaplasty, focusing on key factors influencing flap survival, evaluation methods, and strategies for surgical optimization.

Methods. A narrative and systematic review was performed using PubMed, Scopus, and Web of Science databases. Search terms included breast reduction, flap viability, ICG angiography, Doppler, and superomedial pedicle. Studies published between 2019 and 2025 were included. Extracted data encompassed patient characteristics, surgical techniques, intraoperative perfusion-assessment methods, and outcomes related to flap viability and postoperative complications.

Results. The review identified several patient-related (smoking, diabetes, obesity, age, comorbidities), intraoperative (technique, flap tension, hematoma, infection), and postoperative (smoking relapse, immobilization, infection) factors affecting flap survival. Modern assessment techniques – such as indocyanine green angiography (ICG), near-infrared spectroscopy (NIRS), and color Doppler ultrasonography – enable real-time evaluation of perfusion, significantly reducing ischemic complications. The superomedial pedicle has shown superior vascular reliability and lower rates of areolar necrosis compared with inferior or central pedicles. Preoperative optimization (smoking cessation, glycemic control, weight management), preoperative imaging (CTA, MRI), meticulous surgical handling, and postoperative monitoring represent essential strategies for improving flap viability. Emerging approaches include the use of platelet-rich plasma, growth factor therapies, and AI-assisted perfusion analysis.

Conclusions. Flap viability is a critical determinant of success in breast reduction and reconstructive surgery. Multiple factors influence flap survival, and advanced imaging techniques now provide precise, dynamic assessment of vascular perfusion. Optimal outcomes require an individualized, evidence-based approach combining risk-factor control, refined surgical technique, and integration of technological advances. Future research should aim to refine flap design, validate predictive imaging models, and develop personalized strategies to enhance flap survival and patient satisfaction.