Double Purse String Closure Technique for Minimizing Post-Operative Widening of Periareolar Augmentation Mastopexy: A Comparative Study

Abstract

Objectives: For management of mild degree breast ptosisperiareolar mastopexy had been commonly used. Since Benelli1990 had confined the scar to the areola in his round-blocktechnique, several authors has adopted this technique. Whethermastopexy had been done with or without augmentation, theproblems of breast shape, areolar irregularities,and stretch ofthe areola had been annoying to both patients and surgeons.These problems also represent a major challenge to thistechnique. In this paper purse string closure was used in twoconsecutive different layers one in dermal de-epithelized layerand another in the deep dermis of the skin. The aim is tominimize widening of scars of peri-areolar incision andimprove its long term appearance.Patients and Methods: 50 cases underwent mastopexywith breast augmentation. Cases were divided into two groups:Group A: Underwent closure by single purse string layer andGroup B: Two consecutive purse string closure. The secondconcentric row was applied to the deep dermal plane of thenormal non de-epthelialized skin similar to the classical pursestring closure described previously. Both subjective andobjective evaluation were done. Surgery was done by singlesurgeon and two surgeons not involved in research evaluatedthe post-operative photos. Follow-up was done at 3, 6 monthand at 1 year post-operative.Results: Group B patients showed superior results asregarding breast shape, contour, projection, superior fullness,periareolar scar shape, regularity, areola width and position.These results were followed-up for one year.Conclusion: Decreasing the tension of the periareolar sutureby applying double purse string technique in two differentplanes improved long term results of periareolar scar in orderto avoid widening, irregularities and hypertrophic scarring.