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Letter A incision periareolar mastopexy with breast implant

Kamal H. Saleh
Head of plastic surgery department
Al Emadi hospital, Doha Qatar

Abstract Vertical mammoplasty is an effective

alternative to inverted-T methods.
20 cases of the females with mild to
moderate drooping of breasts, undergone
mastopexy and augmentation of breast at the Among other benefits, it results in a
same time, through letter A (upper half of significantly reduced scar pattern. There
areola) periareolar incision, after pointing
exists a subset of patients with ptosis
the position of new areola towards the
narrow part of letter A. We excised the
who are candidates for a scar pattern that
excess skin, insert the breast implant is further reduced [1].
(silicon, saline filled) according to the size
A technique of mastopexy has been
that the patients selected, closed the skin in
layers. High satisfaction rate about 80% wasoutlined that is extremely versatile for
achieved with very small post operative restoring an aesthetic and youthful breast
scars and few complications. The aim of thisshape in the patient who has lost a
paper is to report our surgical experience in
massive amount of weight [2].
performing one-stage mastopexy with Mastopexy is virtually always required
breast augmentation, with small in the female massive weight loss
The New Iraqi Journal of Medicine 2009 ; 5 (1): Surgical experience
periarolar scar, in 20 patients with patient, and breast augmentation is often
mild to moderate drooping of the an important adjunct to breast-lifting
breasts. procedures [3].

Keywords: Mastopexy, Breast implant, One-stage mastopexy with breast

letter A incision augmentation is an increasingly popular
procedure, although some recommend a
Introduction staged mastopexy and breast
augmentation [4).
The breast is the most important organ in
the female’s bodies, so any deformity to The inverted-T incision for mastopexy of
the breasts will affect their femininity. saggy breast continues to be associated
So there are many procedures to improve with the three most common
the shape of the breasts and correct any complications for this technique; suture
deformity. 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 excessive. Nine such patients received
mastopexy in the augmented breast is this "extended crescent mastopexy with
fraught with potential complications, augmentation" and were followed for up
including fat necrosis, skin flap loss, and to 3 years. Areola spreading and
nipple ischemia. hypertrophic scar were kept to a
minimum. Although not the final answer
The long-term presence of implants for ptosis patients, the extended crescent
typically results in changes in breast mastopexy with augmentation has been a
anatomy and physiology, including step in the right direction [9].
parenchymal atrophy, tissue thinning,
and diminished skin blood supply. These The image of the breast is a symbol of
factors greatly increase the surgical risks femininity and plays an essential role in
of secondary mastopexy [6]. the way a woman looks at herself and
contributes to her personal and social
Primary augmentation/mastopexy is a development. Fashion nowadays
commonly performed procedure and has uncovers rather than covers a woman's
a significantly less complication rate body, and long scars resulting from
than secondary augmentation/mastopexy mammoplasty are less accepted now
which is also common and has higher than they were in the past, more so
revision and complication rates [7]. because the scar quality is unforeseeable.
The main concern of mastopexy is to
In one study the most common limit the scars, creating a nice breast
complications after breast surgery were shape. Ideally scarring is confined to the
hematomas, present in 46 patients periareolar circle [10].
(1.5%), infections in 33 patients (1.1%),
and breast asymmetries in 23 patients Mastopexy and augmentation together
(0.8%), rippling in 21 patients (0.7%), can be a very difficult combination of
and capsular contractures in 14 patients procedures to perform. In many cases,
(0.5%) [8]. the position of the implant can be
inappropriate, necessitating
Problems with circumareolar mastopexy reoperation[11].Periareolar mastopexy
procedures include areola spreading, with mammary implants in treatment of
hypertrophic scar, and recurrence of the ptosis (NAC).This technique does not
ptosis largely because of tension on the allow great elevation of the areola (no
closure. To minimize this tension more than 4-5 cm), but it is good and
associated with a conventional crescent safe for correcting minor to moderate
mastopexy procedure, by excising ptosis combined with volume
parenchyma with the crescent of skin as augmentation[12].
well as two small triangles of
parenchyma on either side of the areola. The aim of this paper is to report our
Implant augmentation was performed at surgical experience in performing one-stage
the same time. The described operation mastopexy with breast augmentation,
is indicated for patients who have a with small periarolar scar, in 20
small to moderate amount of ptosis. The patients with mild to moderate drooping
best candidate is the patient whose of the breasts.
areola-inframammary distance is not

. Table (1): The numbers of the patients
and their age groups

Patients and Methods

5 patients (25%) have good the post-
20 female patients with small to operative scar results after 8 months
medium size breasts with moderate from surgery ,and 2 patients (10%) have
drooping of areolar-nipple complex poor the post-operative scar results after
(ANC) one stage mastopexy 8 months from surgery. Only 3 patients
augmentation of their breasts. Their age developed complications; small
ranged from 29-45 years.14 patients hematoma, wound dehescence, and
(70%) have moderate drooping of the infections.
breasts and 6 patients (30%) have mild 16 (80%) patients were highly satisfied
drooping of the breasts. with surgical results, 2 (10%) patients
were satisfied with surgical results, 2
We prepared the patients and take (10%) patients were not satisfied with
photography, then we draw letter A in surgical results.
upper half of ANC ,the position of new
(ANC) will be in the direction of the Discussion
narrow part of letter A, then we incise
The female when grow older, become
the skin deepithelialized, the triangle of more concerned with the shape of their
letter A. The breast implant inserted breasts. The aging process have great
through the periareolar line of letter A, to role in the sagging of the breast, also
sub glandular area, the parenchymal hormonal changes that affect the breast
breast tissue and the skin sutured in layer paranchymal, glandular tissue, so breast
followed by the application of local become laxly and redundant [13].
antibiotic, and frequent dressing. The
patients were followed up for 2 years The different techniques were evaluated
without recurrence. with regard to patient selection,
operative techniques, scar length, and
Results complications .Plastic surgeons should
weigh the advantages and limitations of
The numbers of the patients have each technique to correctly address
drooping of the breast increased with the breast ptosis [14].The determining
increase of the age as shown in table [1]. variables in the selection are ptosis of the
13 patients (65%) have very good the nipple-areola complex (NAC) and
post-operative scar results after 8 distance from the NAC to the
months from surgery. inframammary fold , in using the
periareolar pexy for correction of ptosis,
the degree of general satisfaction with
this technique was 82% [15].

In this study the surgical results and

satisfaction rate of 80% are
comparable to other
studied[16,17,18].The main limitation of

this report is the small sample of 8-Araco A, Gravante G, Araco F, Delogu D,
patients. Cervelli V, Walgenbach K.

Conclusion: According to our modest A retrospective analysis of 3,000 primary

aesthetic breast augmentations:
experience on this small sample of
postoperative complications and associated
patients, we think it is possible to factors.Aesthetic Plast Surg. 2007 Se;
perform the combined procedure of 31(5):532-9. Epub 2007; 20.
mastopexy and implantation, to 9-Gruber R, Denkler K, Hvistendahl Y.
minimize the complications, and to Extended crescent mastopexy with
obtain satisfactory results over the mid augmentation. Aesthetic Plast Surg. 2006;
and long terms 30(3):269-74; discussion 275-6.
10- Cardenas-Camarena L; Ramirez-Macias
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