J Korean Soc Aesthetic Plast Surg.  2009 Jun;15(2):105-115.

Periareolar Approach for Augmentation Mammoplasty

• Lee EJ

Abstract

The periareolar approach provides central acess to all quadrants of the breast and is compatible with all the various breast implants and planes. This approach is also the choice when considering or planning a simultaneous mastopexy, and is also useful for dual plane dissection. Although the diameter of the areola is a limiting factor when contemplating this approach, areolas as small as 25mm in diameter will allow for creation of a 4-cm incision along one half of the areola circumference. The incision along the areola can also be lengthened by a zig-zag W incision. The damage of the breast parenchyme can be minimizes by making inferior subcutaneous dissection 3-4cm apart from the periareolar skin incision. The lateral edge of the pectoralis major can be identified and lifted easily after vertical cutting of breast parenchyma. The submammary or submucular pocket can be made accurately without difficulty by using blunt dissection or sharp electrocautery dissection. The bleeders are also cauterized easily with good visual field. The lateral branch of the 4th intercostal nerve can be identified and avoided from damage with direct vision. This approach is also effective in removing thick capsule after augmentation mammoplasty. The inferior portion of the pectoralis major is also cut along the inferior margin of the breast for dual plane dissection. The periareolar scar could be minimal by making W-shaped zig zag incision along a irregular skin areolar junction after making nonabsorbable mersilen intradermal suture to prevent scar widening.

Keyword

Mammoplasty; Breast implantation; Breast