The Nipple-areola complex irrigation showed a predominance of arteries from the upper quadrants, both from the internal and external mammary arteries, showing an abundant pattern in superior-interior quadrant. Although the majority of patients with vascular silence in the upper quadrants (61%) had a surgical history, 39% still represents a significant number of patients without a history who present this variant and could benefit from presurgical tomosynthesis to plan a better surgical approach that preserves the existing vascular pedicles.

Radiologists must be familiar with this imaging technique and this modality of evaluation of the irrigation pedicle for the nipple-areola complex to accurately report the information to the surgeon. We must describe not only the vascular predominance of the breast, but the vascular pattern of each quadrant with the number of vessels and their diameter (less than 2 mm can compromise the irrigation of the nipple-areola complex).

Standardizing the use of tomosynthesis as an imaging method in preoperative preparation will contribute to a better evaluation of breast anatomy and planning surgical technique specific for each patient.