{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T02:31:52Z","timestamp":1761186712263,"version":"build-2065373602"},"reference-count":47,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: The nipple\u2013areolar complex (NAC) necrosis is a rare yet significant complication following breast reduction surgery, primarily linked to compromised vascularization of the NAC, particularly in nipple-sparing techniques. While multiple therapeutic strategies have been described in the postoperative setting, their application remains limited in clinical practice. Case series: We report on three patients that developed early NAC venous distress following bilateral breast reduction. Following discussion of therapeutic options\u2014ranging from conventional methods such as scarification and local heparin therapy to off-label pharmacologic treatment\u2014all three patients received oral sildenafil citrate (20 mg every 6 h), after excluding contraindications and obtaining informed consent. In two patients, sildenafil alone was sufficient to restore venous outflow and salvage the NAC. In one case, adjunct scarification and heparin therapy were necessary due to partial response. No arterial damage or major adverse effects related to sildenafil were observed during the postoperative period. Conclusions: This small series supports the potential use of off-label sildenafil citrate as a valuable, non-invasive pharmacologic option for treating postoperative areolar venous congestion. Its favorable safety profile, widespread hospital availability, and mechanism of enhancing microvascular circulation make it a promising adjunct in managing this complication. Further studies are warranted to standardize its use and determine its place within a broader postoperative management spectrum of compromised vascularization in breast surgery.<\/jats:p>","DOI":"10.3390\/life15111644","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T01:14:02Z","timestamp":1761182042000},"page":"1644","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Off-Label Sildenafil Citrate as a Rescue Therapy for Areolar Venous Congestion Post\u2013Breast Reduction: Case Series and Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9552-8558","authenticated-orcid":false,"given":"Stefana Catalina","family":"Bilha","sequence":"first","affiliation":[{"name":"Endocrinology Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eloi","family":"Ramelli","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Hautepierre University Hospital, 67200 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charline","family":"Huttin","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Hautepierre University Hospital, 67200 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8248-216X","authenticated-orcid":false,"given":"Simona Mihaela","family":"Hogas","sequence":"additional","affiliation":[{"name":"Nephrology Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Ringenbach","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, GHR Mulhouse, 68100 Mulhouse, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dumitru D.","family":"Branisteanu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Charles E. Smith College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ileana Katerina","family":"Ioniuc","sequence":"additional","affiliation":[{"name":"Department of Mother and Child, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4260-9565","authenticated-orcid":false,"given":"Ionut-Raducu","family":"Popescu","sequence":"additional","affiliation":[{"name":"Physiology Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihaela Elena","family":"Nastasa","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, GHR Mulhouse, 68100 Mulhouse, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihai","family":"Hogas","sequence":"additional","affiliation":[{"name":"Physiology Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Balogun, O.T., and Wanzel, K.R. (2025). Areolar Contractility as a Sign of Nipple-Areolar Complex Vascular Insufficiency in Reduction Mammoplasty\u2014Bridging the Gap in Breast Surgery for Diverse Skin Tones. Plast. Surg., 22925503251326276.","DOI":"10.1177\/22925503251326277"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12957-023-02898-x","article-title":"Nipple-Areolar Complex (NAC) or Skin Flap Ischemia Necrosis Post Nipple-Sparing Mastectomy (NSM)\u2014Analysis of Clinicopathologic Factors and Breast Magnetic Resonance Imaging (MRI) Features","volume":"21","author":"Lai","year":"2023","journal-title":"World J. Surg. 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