Periareolar Mastopexy Research Articles

Nipple–areola complex sparing mastectomy with periareolar pexy for breast cancer patients with moderately ptotic breasts

Nipple-areola complex sparing mastectomy (NSM) with immediate implant reconstruction has been recently introduced for breast cancer patients who are not candidates for breast preserving surgery. As the cosmetic results in moderately ptotic breasts may not be optimal, a modified NSM with a periareolar pexy (PP-NSM) was introduced at our Institution. Patients selection criteria and complication rates of PP-NSM were prospectively recorded and compared with those of the classical NSM. Over a period of 11 months, 22 PP-NSMs and 35 NSMs were performed. The mean jugular-nipple distance was significantly longer in the PP-NSM as compared with the NSM (22.6 vs. 19.6 cm; p=0.000), whereas the mean inframammary fold-areola distance was superimposable (5.4 cm). The periareolar mastopexy led to a mean cranial transposition of the nipple-areola complex (NAC) of 2.2 cm (range 1.5-4 cm). Mean breast weight was significantly higher in the PP-NSM as compared with the NSM cohort (336 vs. 236 g; p=0.003). The only case of total NAC necrosis occurred in the PP-NSM group. Partial NAC necrosis was slightly more frequent in the PP-NSM than in the NSM group (13.6% vs. 2.9%%; p=n.s.), possibly due to the higher percentage of smokers (41.0% vs. 14.0%; p=0.05). Early cosmetic results were good to excellent from the surgeon's and the patient's point of view in over 80% of the cases. PP-NSM allows good cosmetic results and low complication rates in patients with moderately ptotic breasts requiring a mastectomy. In particular, PP-NSM seems to be a good option for women at high risk for developing breast cancer and for selected patients affected by non-locally advanced breast cancer.

Oncoplastic surgery for Japanese patients with breast cancer of the lower pole

This report presents the results of oncoplastic surgery in three Japanese patients with breast cancer lesions involving the lower pole of the breast. Their breasts were ptotic, and their lesions were considered to be suitable for breast conservation surgery. There were treated with partial mastectomy resection using vertical-scar mammaplasty, with reduction surgery and recentralization of the nipple-areola complex. Two patients underwent a mirror-image biopsy on the contralateral breasts to determine the symmetry. The remaining patient had periareolar incision mastopexy without reduction added for the contralateral breast. A large surgical margin was used to remove excessive skin and parenchymal tissue. Ideal symmetry was achieved by performing reduction and/or mastopexy on the contralateral breast.

Chirurgische Therapie bei Gynäkomastie

Nowadays surgical intervention is an essential part of the treatment of idiopathic gynecomastia. Choosing the right method is crucial and is based on the current status in the clinical and histological evaluation. Before finalizing the process of choosing a specific method a prior interdisciplinary evaluation of the patient is necessary to ascertain clear indications for a surgical intervention. Liposuction is one of the methods which have become popular in recent years. The advantages are the possible combination with traditional techniques, such as subcutaneous mastectomy or periareolar mastopexy. The main indication is for gynecomastia stage IIa/b and is justifiable due to the reduction in surgical complications and scarring. Furthermore this technique provides an excellent aesthetical outcome for the patient. A total of 162 patients suffering from gynecomastia stages I-III (according to Simon) were surgically treated between 2000 and 2010 and these cases were retrospectively evaluated. The results showed a decline in the use of a T-shaped incision in combination with subcutaneous mastectomy with periareolar tightening compared to an increase in the use of subcutaneous mastectomy in combination with liposuction. The excised tissue should always be sent for histological examination to make sure no malignant cells were present.

Conservative Augmentation with Periareolar Mastopexy Reduces Complications and Treats a Variety of Breast Types

Augmentation with mastopexy remains a challenge because reported complication and revision rates remain high. Previous publications are difficult to interpret because of inclusion of a broad array of mastopexy techniques and different implant styles and placements. This is a review of 100 consecutive augmentation/mastopexy patients performed by a single surgeon using a single procedure, implant style, and placement. Between January 2003 and December 2008, 100 female patients underwent primary augmentation mammoplasty with periareolar mastopexy. All patients had either grade II or grade III ptosis, or tubular deformity. All implants were Allergan style 168 (270-390 mL saline prosthesis).All patients (N = 100) were available for follow-up, an average 8.3 months postoperatively (1.5-21 months). Overall complication rate was 11%. Nonimplant-related complication rate was 6%--2 widened scars, 3 hypertrophic scars, and 1 partial nipple necrosis. Implant-related complication rate was 5%--2 deflations, 1 capsular contracture, 1 implant shifting, and 1 infection. Augmentation mammoplasty with periareolar mastopexy treats a wide variety of breast types including tubular deformity and grade II and III ptosis. Planned nipple-areolar elevation should be 4 cm or less. Vertical and horizontal skin envelope redraping is tailored for each case.

Simultaneous Augmentation and Periareolar Mastopexy: Selecting the Correct Implant

Periareolar mastopexy is a well-described technique for cosmetic improvement of breasts classified as Regnault ptosis grades 1 and 2. However, this technique is used less frequently for cases of grade 3 ptosis. Grades 2 and 3 ptosis were corrected for selected patients using a combination of augmentation with Style 410 shaped, form-stable, highly cohesive, silicone gel implants and periareolar mastopexy. In this study, 17 patients were treated. The Style 410 implants used included four different devices: FX (full height, extra-full projection, n = 4), MX (medium height, extra-full projection, n = 1), MF (medium height, full projection, n = 8), and FF (full height, full projection, n = 4). No complications occurred immediately after surgery, and only two cases of capsular contracture Baker grade 2 cases with implant palpability occurred during a mean follow-up period of 18 months. All 17 women were very satisfied with the improvement in their clothed appearance, and 16 were very satisfied overall with their surgery and body image improvements. With proper selection of patients and Style 410 breast implants, cases of grade 3 breast ptosis can be managed successfully by the periareolar approach, thus extending the range of cases suitable for this technique. The different shapes of the Style 410 form-stable, silicone gel implants help to recreate the desired natural-looking breast, achieving stable results with minimal complications.

Simultaneous Augmentation and Mastopexy: Selecting the Correct Implant

Augmentation mastopexy generally is regarded as one of the most challenging aesthetic procedures performed on the breast. Indeed, for many surgeons, the complications associated with breast augmentation and mastopexy are not just additive when these two procedures are performed together. The actually seem to compound each other. It is with this as a general background for the procedure that the report by Rancati and colleagues must be viewed. The ability of the authors to combine a periareolar mastopexy approach with breast augmentation using formstable implants with such a low complication rate speaks highly of their combined technical skill and attentive preoperative planning. With this in mind, several points raised in this report are worthy of comment.

Augmentation Mastopexy in Muscle-Splitting Biplane: Outcome of First 44 Consecutive Cases of Mastopexies in a New Pocket

Augmentation with mastopexy is a commonly performed procedure and is done either simultaneously or in stages. The augmentation component can be accomplished by placing an implant in the subglandular, partial submuscular, or subfascial plane, and mastopexy can be performed using periareolar, vertical, or Wise pattern markings. These two components are independent of each other and any pocket can be combined with suitable external markings. The muscle-splitting submuscular biplane is a new pocket and is combined with conventional envelope reductions for mastopexy. The submuscular biplane pocket was used in 44 consecutive patients for mastopexy and augmentation using vertical scar and periareolar markings. Of these, 13 had subglandular augmentation in the past. The mean age of the patients was 32.4 years (range = 21-46). Average blood loss was 44 g (range = 10-111 g). Drains were used selectively and the procedure was usually done as a day case. The follow-up period of the included cases ranged from 4 months to 3 years. No infection, hematoma, or wound problems were seen. Minor revision was required for periareolar puckering in one case and three had dog-ears after vertical scar mastopexy. One periareolar mastopexy required conversion into a vertical scar as a revision and one vertical scar mastopexy had superficial infection with bilateral minor skin breakdown which responded completely to antibiotics. The submuscular biplane technique is a good option for breast augmentation with mastopexy as a single or staged procedure.

Purse-String Nipple Areolar Reconstruction

We present a surgical technique of nipple areolar reconstruction that uses a purse-string to increase areolar projection while reducing loss of nipple projection. A permanent purse-string is used around a modified CV flap to advance tissue centrally to the base of the nipple reconstruction. Two opposing hemiareolar island flaps are advanced toward the base of the nipple to add tissue volume. The resulting circumareolar full thickness skin is closed using a permanent purse-string suture. Synching the purse-string suture produces an effect similar to that of a periareolar mastopexy and enhances areolar projection. Eighty-two patients underwent 108 nipple areola reconstructions. Ninety-six percent of the patients achieved good results without any flap loss or suture infections. Revision surgery was necessary in 4 patients for minor problems including asymmetry or loss of projection. The purse-string nipple areolar reconstruction method described results in a high rate of maintenance of projection and patient satisfaction.

Relationship of Incision Choice to Capsular Contracture

Capsular contracture can be an ongoing problem in breast augmentation even with good surgical technique. In the author's practice, a higher incidence of capsular contracture was observed with the use of a periareolar incision than with an inframammary incision. A review of breast augmentations performed from November 2004 through June 2006 was conducted. This analysis included the incision used, the procedure performed, and the development of capsular contracture. The incidence of contracture was 0.59% in the inframammary group and 9.5% in the periareolar group. This increase in capsular contracture with a periareolar incision was statistically significant. Capsular contracture occurring with augmentation performed at the time of a periareolar mastopexy was 8%, which was statistically significant compared with the inframammary group. The difference in contracture rates between a periareolar incision alone and a periareolar mastopexy was not statistically significant. Breast augmentation through a periareolar incision has a higher incidence of capsular contracture than observed with an inframammary incision. This most likely occurs due to an increase in contamination of the breast pocket with intraductal material colonized by bacteria. The periareolar incision is, and will remain, a standard of care. Therefore, this information can help clinicians make a more informed decision regarding incision placement for breast augmentation.

Periareolar mastopexy and augmentation

The author performs periareolar mastopexy only in cases requiring correction of moderate ptosis and skin redundancy. The size and shape of the implant to be used and the surgical plan are both decided at consultation. The author prefers high-textured cohesive silicone gel-filled implants placed in the subpectoral position. To facilitate the surgical procedure, the author administers profuse local anesthesia and leaves compresses in the dissected pocket. The use of a cinching running suture helps to obtain a good-quality periareolar scar with minimal wrinkling. These techniques can reduce the incidence of complications and minimize the need for surgical revision.

Breast autoaugmentation

A technique using a posteriorly based dermoglandular flap as an augmentation of the superior hemisphere of the breast combined with a periareolar mastopexy and vertical mastopexy is presented. The advantages of combining a periareolar mastopexy, in terms of reducing the length of the vertical scar and preventing areolar distortion, are explained.

PR51 AUGMENTATION MASTOPEXY

Introduction Augmentation‐Mastopexy is a more complex procedure than either breast augmentation or mastopexy performed individually. Since the operation both increases breast size and corrects ptosis in one surgical procedure, the combination has been considered to be associated with increased risk of complications. Complications most commonly include ischemic related complications of the breast flaps or nipple areolar complex and loss of sensibility. While some authors have suggested a staged approach with augmentation followed by mastopexy, I prefer to perform augmentation mastopexy as a single technique which is an attractive alternative to two operations. The principles include initial insertion of the implant in either the subglandular or submuscular position followed by mastopexy which can be periareolar, vertical, or inverted‐T scar based on the degree of ptosis and size of the breast.Methods/Technique Augmentation is performed first so the amount of ptosis can be evaluated after the augmentation in order determine the type of mastopexy performed. The implant is placed through a periareolar incision or a vertical lower pole incision if one anticipates a vertical mastopexy scar. Implant placement is generally subglandular when sufficient soft tissue exits to provide adequate implant coverage. Care should be taken to preserve a dermal pedicle for blood supply to the nipple since subglandular dissection reduces the blood supply to the nipple areolar complex. When the breast soft tissue envelope is thin, submuscular placement is preferred for additional implant coverage. Since submuscular placement provides better coverage, there is generally less palpability and rippling. Furthermore, submuscular dissection preserves better blood supply exits to the NAC. A disadvantage of submuscular placement is increased risk of a high riding implant. The mastopexy should adequately elevate the breast to avoid a double bubble deformity is performed.Results Over the past 12 years, 98 augmentation mastopexies were performed. The average pre‐operative bra size was B‐cup and the average degree of ptosis was Grade II. The mean patient age was 55. Smooth round gel implants were used for 90% of the patients. 80% were placed submuscular and 20% were placed subglandular. A Periareolar mastopexy was performed in 25% of patients and an inverted T mastopexy was performed 75% patients. Periareolar augmentation mastopexy was performed commonly for the correction of tubular breast deformity.Generally, most patients were satisfied with their procedure as only 5% underwent revision for aesthetic indications. 2% patients suffered acute complications including hematoma and loss of nipple sensation. 9% suffered subacute and chronic complications including delayed wound healing, loss or partial loss of the NAC, and loss of nipple sensation. 5% patients required revisions surgery to correct the sequelae of delayed wound healing or NAC tissue loss.Conclusions Augmentation‐mastopexy is one of the most complex and technically demanding procedures performed in aesthetic breast surgery. Nonetheless, there is a role for the procedure due to its ability to reduce the number of procedures and provide improved breast shape. The key to success is to be aware of the most common complications and to proceed in a stepwise in order to minimize the risk of complications and maximize patient satisfaction.

An Algorithm for the Treatment of Complications in Peri-Areolar Augmentation Mastopexy

An Algorithm for the Treatment of Complications in Peri-Areolar Augmentation Mastopexy

Simultaneous breast augmentation with periareolar mastopexy.

Augmentation mammaplasty is frequently used to fill out the soft tissue envelope of the breast. This is most successful with minimal skin laxity or when there is no need for significant nipple movement. The addition of a periareolar mastopexy can reduce the skin envelope; however, its value is limited to those with no more than mild second-degree ptosis. Although this is a valuable technique, the risks involved with the operation are additive, and, accordingly, patient selection and surgical technique is important.

Indications and practical applications for high-profile saline breast implants

Background High-profile round saline breast implants that permit a better match of implant diameter to the base diameter of the breast are now available. Objective The advantages and disadvantages of high-profile breast implants are defined from the point of view of the author's initial experience. Methods The maximal optimal breast implant was determined on the basis of preoperative measurements, with emphasis on breast base diameter. Patients selected implant size using trial implants in a bra of the desired cup size. The implant profile with the best match to breast base diameter at the selected size range was used. Results Sixty-seven patients, of a total of 164 patients who received saline breast implants during a 14-month period, received high-profile breast implants. Conclusions High-profile saline implants provide a useful option for the patient who desires an implant size that exceeds the natural breast base diameter in standard profiles. Rippling may be diminished in these cases. A more conical shape may be achieved in cases of periareolar mastopexy with augmentation. Disadvantages of the high-profile design include less mobility of the implant and a less obtuse transition from the chest to the upper breast compared with results achieved with standard round implants.

Treatment of breast ptosis

Dr. Colen: The first patient is a 29-year-old woman who underwent a periareolar subpectoral augmentation with a round, smooth saline implant 1 year ago (Figure 1). Dr. Giese, can you describe this patient's problem and how it might have been avoided? Dr. Giese: In this oblique view, it appears that the patient has a double-bubble deformity. In addition, her breast mound and the implant appear unequal; her left breast seems higher on the chest wall than the right. Figure 1 This 29-year-old woman underwent periareolar subpectoral augmentation with a round, smooth saline implant 1 year ago. She does not like the appearance of her breasts. To avoid the occurrence of a double bubble, I would not have chosen to obliterate the natural inframammary fold, if possible. The natural inframammary fold acts as a very strong sling to keep the implants properly positioned on the chest wall. Here, the implant has fallen beyond the natural portion of her breast and into the surgically created inframammary fold pocket. This patient needed an augmentation mastopexy. I like the periareolar approach and the subpectoral position with a round, smooth saline implant, but, again, I would have tried to avoid lowering or changing her natural inframammary folds. Maybe that would have meant using a smaller implant. I do not know what necessitated lowering the folds. Dr. Colen: Dr. Hammond, what would your initial approach to this patient have been? Dr. Hammond: If I felt that she needed a mastopexy, I would have performed a periareolar mastopexy without hesitation. When I am already in the periareolar incision, I use that to gain access to the breast; it is a very nice approach to the lower breast apron. The inframammary-fold incision sometimes masks the location of that fold when the implant is inserted. But from above, through the periareolar …

Periareolar mastopexy: Double skin technique with mesh support

In the author's view, the double-skin technique for reduction mammaplasty and mastopexy, incorporating mesh as support, results in improved anterior projection and reduces scars without increasing morbidity or interfering with mammography. Here, he describes his operative technique. (Aesthetic Surg J 2003;23:129-135.)

Unsatisfactory results of periareolar mastopexy with or without augmentation and reduction mammoplasty: enlarged areola with flattened nipple.

A method of repair is described for correction of abnormally enlarged nipple-areola complex following both periareolar mastopexy and pregnancy. Although during periolar mastopexy or reduction mammoplasty regular subcuticular dermal sutures may control the enlargement of nipple-areola complexes initially, the periareolar scar becomes hypertrophic and areolar spreading occurs to some extent. Periareolar mastopexy techniques are indeed advisable only for minimal hypertrophies or ptosis of the breast, especially for areolar asymmetry, if an acceptable, normal-size areola is expected. The authors believe that in periolar mastopexy or reduction mammoplasty cases resulting in enlarged nipple-areola complexes, the size of the areola can also be corrected by reduction mammoplasty or mastopexy using vertical bipedicle techniques. Although surgery results in an inverted T incision, the shape of the breast is more acceptable and the size of the areola does not enlarge with time.

Augmentation of the ptotic breast: Simultaneous periareolar mastopexy/breast augmentation

Background: Submusculofascial augmentation of the ptotic breast can result in a “double-bubble”appearance, because a submusculofascial implant will lay superior to the ptotic gland. Subglandular augmentation in a ptotic breast avoids a “double-bubble” but will aggravate the preexisting ptosis. Objective: The purpose was to review the technique of augmentation of the ptotic breastwith a submusculofascial implant and simultaneous periareolar mastopexy. Methods: Twenty-three patients were treated with the technique of simultaneous periareolar mastopexy/breast augmentation over a period of 18 months. Results: This technique avoids the “double-bubble” appearance and leaves a minimal periareolar scar. There was one complication, a case of partial areolar necrosis. The most common errors in surgical technique were inadequate elevation of the nipple-areolar complex, inadequate periareolar skin excision, and the use of too small an implant. Conclusions: Simultaneous periareolar mastopexy/breast augmentation is useful for augmenting the ptotic breast when augmentation alone will fail to give a satisfactory aesthetic result.

Management of displaced breast implants

V. Leroy Young, MD Claude Lassus, MD L. Franklyn Elliott, MD Walter J. Peters, MD Dr. Young: The first patient (Figure 1) is a 28-year-old woman who had bilateral subglandular breast augmentations with 350 ml smooth-surface, silicone gel-filled implants through a periareo-lar incision. Her breasts were symmetrical before augmentation. She has bilateral grade II capsular contractures. She is unhappy because the right implant is higher than the left implant. Dr. Elliott, what do you think caused this problem, and how can it be avoided? We would also like to know how you would correct this problem. Figure 1 A 28-year-old patient with bilateral grade II capsular contractures. Her right breast implant is higher than her left implant. Dr. Elliott: This is a relatively common problem that is usually caused by asymmetric upward forces associated with capsular contracture. For example, a grade III capsular contracture on the right versus a grade II capsular contracture on the left could displace the right implant superiorly. However, because the two breasts are equally soft, capsular contracture is not the cause, and I would assume that the difference exists because the right implant was placed higher than the left implant. Patients with this type of deformity are frequently unhappy with both breasts and usually have better results when both breasts are revised. The position of her nipples appears to be slightly low with a supraster-nal notch to nipple distance that is greater than normal (18 to 24 cm); I would measure this distance. I usually choose a distance of 21 cm from the sternal notch, assuming that the patient is 5 foot 4 inches to 5 foot 8 inches tall. If the nipples required elevation, I would use a periareolar mastopexy and discuss the pros and cons of silicone gel-filled implants versus saline-filled implants. In many patients …