Letter A incision periareolar mastopexy with breast implant augmentation
Kamal H. Saleh Head of plastic surgery department Al Emadi hospital, Doha Qatar
drkhsh2001@yahoo.com
Abstract
The New Iraqi Journal of Medicine 2009 ; 5 (1): Surgical experience
20 cases of the females with mild to moderate drooping of breasts, undergone mastopexy and augmentation of breast at the same time, through letter A (upper half of areola) periareolar incision, after pointing the position of new areola towards the narrow part of letter A. We excised the excess skin, insert the breast implant (silicon, saline filled) according to the size that the patients selected, closed the skin in layers. High satisfaction rate about 80% was achieved with very small post operative scars and few complications. The aim of this paper is to report our surgical experience in performing one-stage mastopexy with breast augmentation, with small periarolar scar, in 20 patients with mild to moderate drooping of the breasts.
Keywords: Mastopexy, Breast implant, letter A incision
Introduction
The breast is the most important organ in the female’s bodies, so any deformity to the breasts will affect their femininity. So there are many procedures to improve the shape of the breasts and correct any deformity.
Vertical mammoplasty is an effective alternative to inverted-T methods.
Among other benefits, it results in a significantly reduced scar pattern. There exists a subset of patients with ptosis who are candidates for a scar pattern that is further reduced [1].
A technique of mastopexy has been outlined that is extremely versatile for restoring an aesthetic and youthful breast shape in the patient who has lost a massive amount of weight [2]. Mastopexy is virtually always required in the female massive weight loss patient, and breast augmentation is often an important adjunct to breast-lifting procedures [3].
One-stage mastopexy with breast augmentation is an increasingly popular procedure, although some recommend a staged mastopexy and breast augmentation [4).
The inverted-T incision for mastopexy of saggy breast continues to be associated with the three most common complications for this technique; suture spitting, excess scarring, and bottoming out [5].With time, the augmented breast frequently becomes ptotic and patients may return requesting mastopexy. Experience has shown that secondary mastopexy in the augmented breast is fraught with potential complications, including fat necrosis, skin flap loss, and nipple ischemia.
The long-term presence of implants typically results in changes in breast anatomy and physiology, including parenchymal atrophy, tissue thinning, and diminished skin blood supply. These factors greatly increase the surgical risks of secondary mastopexy [6].
Primary augmentation/mastopexy is a commonly performed procedure and has a significantly less complication rate than secondary augmentation/mastopexy which is also common and has higher revision and complication rates [7].
In one study the most common complications after breast surgery were hematomas, present in 46 patients (1.5%), infections in 33 patients (1.1%), and breast asymmetries in 23 patients (0.8%), rippling in 21 patients (0.7%), and capsular contractures in 14 patients (0.5%) [8].
Problems with circumareolar mastopexy procedures include areola spreading, hypertrophic scar, and recurrence of the ptosis largely because of tension on the closure. To minimize this tension associated with a conventional crescent mastopexy procedure, by excising parenchyma with the crescent of skin as well as two small triangles of parenchyma on either side of the areola. Implant augmentation was performed at the same time. The described operation is indicated for patients who have a small to moderate amount of ptosis. The best candidate is the patient whose areola-inframammary distance is not excessive. Nine such patients received this extended crescent mastopexy with augmentation and were followed for up to 3 years. Areola spreading and hypertrophic scar were kept to a minimum. Although not the final answer for ptosis patients, the extended crescent mastopexy with augmentation has been a step in the right direction [9].
The image of the breast is a symbol of femininity and plays an essential role in the way a woman looks at herself and contributes to her personal and social development. Fashion nowadays uncovers rather than covers a woman’s body, and long scars resulting from mammoplasty are less accepted now than they were in the past, more so because the scar quality is unforeseeable. The main concern of mastopexy is to limit the scars, creating a nice breast shape. Ideally scarring is confined to the periareolar circle [10].
Mastopexy and augmentation together can be a very difficult combination of procedures to perform. In many cases, the position of the implant can be inappropriate, necessitating reoperation[11].Periareolar mastopexy with mammary implants in treatment of ptosis (NAC).This technique does not allow great elevation of the areola (no more than 4-5 cm), but it is good and safe for correcting minor to moderate ptosis combined with volume augmentation[12].
The aim of this paper is to report our surgical experience in performing one-stage mastopexy with breast augmentation
المزيد
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