Posted on July 12, 2010 in Breast lift (Mastopexy), Perioarolar mastopexy, Scar
My philosophy for breast lift surgery is that it is better to use more or longer incisions if the final outcome will be far superior in contour and general aesthetics than that obtained by gimmicky usage of limited incisions. This has been reviewed in two previous posts (Periareolar Mastopexy: Sacrificing Shape and More for Less Incisions and The Lollipop Mastopexy: Shorter Incisions and Lesser Results)
The goal for a mastopexy should be to sculpture a natural appearing breast with a conical shape where the nipple-areola complex is situated at the most projecting portion of the breast. Significant deviations from this detract from the result and can lead to understandable dissatisfaction with the outcome. The technique that provides the most flexibility and precision for contouring and rejuvenating the breast three dimensionally as well as appropriately positioning the nipple-areola complex is the anchor shaped approach.
With the periareolar technique(also known as circumareolar, donut or purse string mastopexy), the lift, contouring, removal of excess skin and repositioning of the nipple-areola complex are all performed by essentially creating a donut shaped defect and purse stringing it closed. Clearly, this doesn’t allow for nuanced three dimensional correction. Furthermore, it creates an abnormal flatness precisely where one isn’t desired – where the nipple-areola complex is located and where the most projecting part of the breast should be. Common sequelae of the donut mastopexy are also wide, dysaesthetic scars, abnormally shaped and flattened areola and the appearance of pleats emanating from the areola outwards.
A vivid illustration of these issues can be seen in the photos below of a 36 year old woman who sought my help in consultation for the correction of her suboptimal results. She had undergone a periareolar mastopexy with implants by another plastic surgeon and was extremely unhappy with the outcome. Particularly problematic for her were the prominent scars, irregularities of the areolas and the overall breast shape. Had an anchor shaped scar mastopexy been chosen and performed well, it is highly probable that the outcome would have been far superior.
The results of a periareolar mastopexy performed by another plastic surgeon. The scars around the surgically deformed areola are extremely prominent, wide and unacceptable. Note the pleating effect - lines in the skin radiating outwards from the areola.
The scars from the donut mastopexy are quite apparent from virtually all angles. The flattening effect created by the purse string technique is well delineated in the right breast in this view. Rather than having a perky, conical shaped breast the result here is an abnormal, flattened, underprojecting one.
Unattractive and unacceptable scars on left breast from the donut mastopexy
Associated donut mastopexy scars on right breast
If you have any questions regarding breast lifts with or without a breast augmentation or on any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on November 9, 2009 in Breast lift (Mastopexy), Lollipop mastopexy, Nipple-areola complex, Perioarolar mastopexy
A patient recently sought my expertise regarding the poor results that she obtained from a mastopexy with implants that was performed elsewhere (by a surgeon who was not board certified). She was very unhappy with the outcome for many reasons but the abnormal shape including the flatness and lack of appropriate projection and the low position of her breast on the chest were the most important issues. To her, the breasts looked bizarre making her feel very self-conscious and frustrated.
She originally presented to the surgeon with drooping (ptosis) and wanting to be larger. The physician recommended a lollipop mastopexy to her without enumerating its pros and cons and did not discuss the much more commonly used inverted-T incision. (A lollipop mastopexy is a breast lift that involves an incision around the nipple-areola complex that then extends down to the breast fold but does not extend along this fold which is employed in the inverted-T technique.)
Her photos can be seen below on the left:
The patient's "lollipop" mastopexy performed by another surgeon. Note the flatness of the breast and droopy appearance with it hanging down well below the breast crease.
This is a mastopexy using a T-shaped (anchor) incision. Note the more pleasing and natural conical shape with greater projection and fullness.
Ignoring factors specifically related to the surgeon, her results also reflect the inherent deficiencies with a lollipop mastopexy. As I noted elsewhere (Periareolar Mastopexy: Sacrificing Shape for Less Incisions), the goal of a breast lift is to recreate a more conically shaped breast with the nipple-areola positioned at the most projecting part. The “standard” inverted-T or anchor shaped approach allows for the precise recontouring of the skin envelope in addition to the underlying breast tissue by utilizing a three dimensional approach. This also facilitates greater accuracy in the placement and size of the nipple-areola so as to create a well shaped aesthetically pleasing breast.
Though the lollipop mastopexy can provide a better shape than what can be obtained with the even more restrictive periareolar mastopexy, its shortcomings are obvious as you can see in these photos. Without being able to adequately remove most of the vertical skin excess that occurs with droopy breasts, the breast remains droopy and abnormally flat including at the nipple-areola complex. Volume that could be used to increase forward projection and yield a more conical shape is instead hanging down, well below the breast crease that is should remain largely above.
Similar to my sentiments regarding a periareolar mastopexy, it is my opinion that a lollipop mastopexy is rarely indicated except for limited situations involving very minor drooping. The tradeoffs in shape and position are too high a price to pay for most women versus the vastly superior results that can be obtained with an additional incision along the breast crease.
If you would like additional information on breast lifts, breast augmentation or any other cosmetic surgery procedure that I perform or you would like to schedule a complimentary consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on October 19, 2009 in Breast lift (Mastopexy), Nipple-areola complex, Perioarolar mastopexy
A periareolar mastopexy, also known as a purse string, doughnut or circumareolar mastopexy, is a breast lift that accomplishes the result with just one incision: around the areola. Many women find the idea attractive because of the idea that there may be fewer scars on the breast. Unfortunately, unless there is minimal drooping to begin with, the trade-off is a poorly shaped flattened breast.
The goal of a breast lift or mastopexy is to recreate a more somewhat conical shaped breast with the nipple-areola situated at the summit of the most projecting part. A “standard” inverted-T or anchor shaped incision allows for precise reshaping of the skin envelope in addition to the underlying breast tissue by utilizing a three dimensional approach. The nipple-areola complex can then be more accurately placed and sized so as to result in an aesthetically pleasing contoured breast.
Inverted "T" Shaped Incision
The periareolar mastopexy approach eliminates the vertical scar as well as the horizontal scar in the fold at the bottom of the breast. Through a two dimensional approach involving just the incision around the areola, it has to both lift and reshape the breast. It accomplishes both by removing excess skin asymmetrically around the areola, taking a larger circle and purse stringing it to make a smaller circle, thereby tightening the skin.
With this approach, the area of maximum tension is centered around the areola. Some of the untoward consequences of this can include but are not limited to:
1.) a flattening of the breast shape creating more of a pancake configuration than a cone
2.) stretching and flattening of the areola causing distortions and irregularities of shape
3.) unsightly pleating of bunched up skin around the areola resulting from the purse string closure
4.) widened and thickened scars around the areola
5.) limitations in the precise positioning of the areola on the breast
6.) difficulty in obtaining closer symmetry is breasts that are significantly different prior to surgery
Periareolar Mastopexy (A). Though mild in this case, flatness and some pleating of the skin of the left breast can be seen centered at the areola (not my patient)
Periareolar mastopexy (B). Greater flattening can be seen including at the lower part of the breast
I strongly feel that a periareolar mastopexy is very rarely indicated except for certain limited situations involving very minor drooping. The trade-offs as noted above are too high a price to pay for most women versus the far superior results that can be obtained with a few more incisions.
If you would like additional information on breast lifts, breast augmentation or any other cosmetic surgery procedure that I perform, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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