Periareolar Mammaplasty Research Articles

Reply to "The Limitations of Periareolar Mammaplasty".

Reply to "The Limitations of Periareolar Mammaplasty".

Application of Periareolar Mammaplasty with the Tissue Folding Technique in Breast Reshaping following Polyacrylamide Hydrogel Removal

Background: Polyacrylamide hydrogel (PAAG) was used as an injectable implant for augmentation mammoplasty for over 30 years, but its use was ceased due to various related complications. The only way to treat these complications is PAAG removal, but this causes breast ptosis, nipple retraction, breast asymmetry, and skin laxity. Objectives: This article reports a new technique for breast reshaping after PAAG removal without prosthesis implantation. Method: From January 2015 to June 2018, twenty-three patients underwent periareolar mammoplasty with the tissue folding technique (PMTFT) for breast reshaping after PAAG removal. Postoperative breast shape and the degree of satisfaction of the patients were evaluated during follow-up. Results: All patients recovered well without severe complications. All patients were satisfied with their postoperative breast shape and their symptoms were relieved after surgery. Conclusions: PMTFT provides satisfactory postoperative breast shape results. Economical, practical, and technical advantages were found over traditional prosthesis-mediated breast reconstruction. PMTFT can be an ideal surgical choice in appropriate cases.

P094. Clinical feasibility of Cerenkov Luminescence Imaging (CLI) for intraoperative assessment of tumour excision margins and sentinel lymph node metastases in breast-conserving surgery

P094. Clinical feasibility of Cerenkov Luminescence Imaging (CLI) for intraoperative assessment of tumour excision margins and sentinel lymph node metastases in breast-conserving surgery

P093. Modified periareolar mammaplasty (MPM) for wide local excision of breast cancers in the upper half of the breast

P093. Modified periareolar mammaplasty (MPM) for wide local excision of breast cancers in the upper half of the breast

The Application of Mesh Support in Periareolar Breast Surgery: Clinical and Mammographic Evaluation

Numerous techniques have been described for the treatment of breast hypertrophy and ptosis. Unfortunately, recurrent ptosis after mammaplasty can occur regardless of the technique used. To avoid this problem, different kinds of supporting devices have been described with variable rates of success. However, the true implications of incorporating prosthetic materials into breast surgery have never been clarified. Therefore, surgeons have traditionally been reluctant to apply any kind of prosthetic material to the breast, fearing inflammation, an unfavorable aesthetic outcome, palpable or visible deformities, and interference with the mammographic evaluation of breast cancer. This study analyzed the aesthetic, clinical, and mammographic implications of using mesh as a supportive device in periareolar breast surgery. For this study, 18 patients (mean age, 42 years) with breast hypertrophy, ptosis, or both were managed with the double-skin periareolar mammaplasty technique, with placement of mixed (60% Polyglactine and 40% polyester) mesh. Clinical assessment was performed by three breast surgeons actively working on cancer surveillance who knew that the patients had experienced mesh application. After a mean follow-up period of 30 months, a standard mammogram was performed for each patient and analyzed by both the surgeons and an expert radiologist. The evaluated factors were hyperemia, calcifications, contour irregularities, capsular contraction, thickening or widening of the scar with extrusion of the mesh, and any palpable or hardened areas. According to the authors' clinical observations, there were no mesh-related abnormalities in the breast; the mesh was not palpable after the operation; and there was no recurrent ptosis. In terms of mammographic imaging, the mesh was visible as a very fine line in the periphery of the breast's parenchyma (measuring 0.2 mm on the lateral views) in three patients (17%). The mesh did not interfere with the visualization and analysis of the breast's parenchyma. In seven patients (39%), benign localized microcalcifications were detected in the breast and no further investigation was performed. In two patients (11%), grouped calcifications were detected and biopsied, with histopathologic analysis demonstrating epithelial hyperplasia with atypia. In two patients (11%), nodules smaller than 1 cm were detected and biopsied, with histopathologic analysis demonstrating a fibroadenoma in one patient and an invasive ductal carcinoma in the other. The use of mesh support in breast surgery can enhance the aesthetic results without inducing visible or palpable deformities or mammographic abnormalities. In terms of surveillance mammograms, the presence of the mesh did not interfere with the diagnosis and treatment of minute lesions such as calcifications and small nodules.

Combination of the vertical and periareolar mammaplasty

Combination of the vertical and periareolar mammaplasty

Periareolar Mammaplasty for Treatment of Gynecomastia with Breast Ptosis and Excess Skin

Many surgical techniques have been proposed for the treatment of gynecomastia with excess skin. Most of them leave long, visible scars, and do not always elevate the nipple–areola complex. The use of periareolar mammaplasty associated with inferior or superior pedicle flaps embodying the areola has the objectives of elevating the nipple–areola complex and removing excess skin and adipoglandular tissue. Permanent periareolar circling is applied to prevent late widening of the nipple–areola complex. The final scar is circular and around the periphery of the areola. The procedure is described, including postoperative evolution and results.

Wineglass pattern for vertical mammaplasty.

The ideal reduction mammaplasty technique should create a pleasing breast shape with minimal scarring. The long and conspicuous scar associated with the classic inverted "T" pattern mammaplasty techniques are not acceptable for many patients. Periareolar mammaplasty techniques cause less scarring, but they have major disadvantages such as scar widening, areolar distortion, and insufficient breast projection. We used a new pattern for vertical mammaplasty to overcome the insufficient breast projection caused by the round block technique and applied it to 51 patients during the last 3 years. This method results in a single vertical scar and a periareolar scar, allows sufficient volume reduction, and provides good breast shape and projection; the results are durable. This procedure is safe, causes few complications, and is easy to learn and perform.

Combination of the vertical and periareolar mammaplasty.

Vertical mammaplasty has been perfected and popularized by Madeline Lejour; this technique is one of the most versatile methods of mammaplasty today. The vertical scar from the nipple areola to the submammary line is often much longer and distorted than the conventional mammaplastys. The length of the vertical scar can be reduced by 2-3 cm by combining the skin pattern of the periareolar and vertical mammaplasty. The aesthetic result can be improved by shortening the vertical scar.

Periareolar mammaplasty with mixed mesh support: The double skin technique

My 8-year experience of operating on 287 patients via a personal mammaplasty technique with a periareolar approach is presented. The technique is based on the principle that the skin alone does not prevent early ptosis. It proposes the repositioning of all breast connective structures, treating the glandular tissue separately from the cutaneous covering. This cutaneous covering is double-layered, using a circular flap of deepithelialized dermis over the central pedicle around the areolar region as the inner layer. For this purpose, the following structures have been used which, once repositioned and brought together, will act as a support network: (1) the anterior pectoral fascia; (2) Cooper's intramammary ligaments; (3) a periareolar dermal flap, used as a skin inner lining; (4) mixed mesh (polyglactine plus polyester) positioned as a sandwich between both layers of skin; and (5) the external cutaneous covering that completes the double-layered skin assembly.

Periareolar mammaplasty: double skin technique with application of polyglactine or mixed mesh.

This paper presents the author's experience of 7 years in 254 patients operated on using a personal mammaplasty technique with a periareolar approach. The technique is based on the principle that the skin alone does not prevent early ptosis. This paper proposes the repositioning of all breast connective structures, treating the glandular set separately from the cutaneous lining, which is doubled, applying a circular flap of dermis with the central pedicle to the areolar region. For this purpose, the following structures have been employed, which, once repositioned and together, will act as a support network: (1) anterior pectoral fascia, (2) Cooper's intramammary ligament, (3) periareolar dermal flap, employed as skin inner lining. (4) application of absorbable polyglactine 910 or mixed mesh (with polyester) as a sandwich between both layers of skin, and (5) external cutaneous lining that composes the assembly of double skin.

Combination of the Vertical and Periareolar Mammaplasty

Combination of the Vertical and Periareolar Mammaplasty

Periareolar Mammaplasty with Silicone Supporting Lamina

A mammaplasty technique through a periareolar incision and inferior pedicle trilobar flap with inclusion of a silicone supporting sheet was used in 485 patients between July of 1985 and December of 1989. The indications for the surgical treatment were ptosis, moderate to severe hypertrophy, or the association of both. The results were satisfactory in 458 patients (94.4 percent). The mean follow-up period was 22 months (range 6 to 50 months) in 427 patients without recurrences or functional alterations. No pathologic processes were observed as a result of use of the prosthesis. The silicone sheet did not interfere with manual, mammographic, or xeromammographic periodic examinations of the gland performed during the follow-up period. This technique has made it possible to mold the breast properly and to preserve its anatomic and functional unity, and in addition, it minimizes the scar and avoids recurrences.

Periareolar Mammaplasty with Silicone Supporting Lamina

Periareolar Mammaplasty with Silicone Supporting Lamina