Blood supply to the nipple

Dr Peet van Deventer’s groundbreaking studies into the blood supply to the nipple-areolar complex area have made breast surgeries safer.

Not a great deal was known about the blood supply to the nipple-areolar complex area before reconstructive and plastic surgeon Dr Peet van Deventer, who operates from Mediclinic Louis Leipoldt and Hermanus, did his pioneering work. In fact, the information didn’t even appear in most anatomical textbooks.

Given that compromising this vital supply of blood can lead to serious problems, including necrosis and the subsequent loss of the nipple, it is essential that a surgeon is well acquainted with the blood supply to the entire breast prior to performing procedures like a breast lift.

Dr Van Deventer’s research at Stellenbosch University included injecting the breasts of female cadavers with latex and dissecting the breasts to determine the main sources and pattern of blood supply to the nipple. He noted that the small vessels feeding the nipple-areolar complex are, in turn, fed by much larger vessels, the most prominent of which are the internal thoracic artery (internal mammary) and the lateral thoracic artery. Based on this, it would appear that the second and third intercostal perforator off the internal thoracic artery are the main vessels supplying the nipple-areolar complex.

This research, which was initially published in the journal Aesthetic Plastic Surgery in November/December 2004, laid the foundation for safer breast surgery. In the March 2008 edition of the same journal, Dr Van Deventer had another paper published on the safety of pedicles in cosmetic breast surgery.

An in-depth knowledge of the blood supply to the nipple is especially important in Dr Van Deventer’s own pioneering breast-lift procedure, which employs a unique permanent internal mesh system that has delivered better results for breast support in the long term. ‘It’s a more intensive procedure and you’ve got to undermine more widely than in a traditional breast-lift procedure, so maintaining the integrity of the blood supply is crucial,’ he explains.

Dr Van Deventer repurposes the gauze that has been used for more than 40 years in hernia repairs to make a unique mesh ‘bra’ that is attached to the chest wall, under the skin. Since performing the procedure for the first time in 2004, he has done more than 180 of these operations to date.

Not only have the outcomes been progressively better over the years, but the availability of suitable materials has also improved considerably and nowadays there are many more meshes on the market. ‘I prefer the polyester-type meshes, but I’ve also used the polyglactin/polypropelene mixed meshes,’ says Dr Van Deventer. ‘Each year there are developments in this field, with new meshes being introduced and we always look into those.’

He stresses that the biocompatible gauze is a foreign material, so the patient may have a reaction to it, but adds that the quantity of material used is much less that the quantity of silicone used in breast augmentations. ‘So broadly speaking, the risks compare very favourably,’ says Dr Van Deventer.

The ‘internal bra’ lift is ideal for post-childbearing women with healthy breast tissue and is also used in breast reconstruction procedures for the purposes of symmetry. ‘The reconstructed breast always looks more perky, so we use the internal bra in the other breast to ensure they look the same,’ says Dr Van Deventer.

Dr Van Deventer was honoured by the Association of Plastic and Reconstructive Surgeons of South Africa (APRSSA) in October 2016 for his paper on the blood supply to the breast, which included his research done over many years that appeared in the leading international journal Plastic and Reconstuctive Surgery. This is the third time he’s won the award, after his work was named Best Publication in both 2010 and 2011.

Dr Van Deventer has become a surgeon of world renown and has presented papers at numerous local and international plastic surgery congresses. He was honoured with an award from the British Association of Aesthetic Plastic Surgeons in 2009. And in 2014 he was guest speaker and presented papers at the Edinburgh meeting of the European Society of Plastic, Reconstructive and Aesthetic Surgery.