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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_654_Библиотеки_им_академика_М_И_Перельмана
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Fig. 11.14 (a–c) Creation of the NAC ap based medially
11.4.1.7 Step 6: Approximation oftheAreola
totheSkin Flap
The skin ap is approximated to the areola in such a way that
there is no tension when closing the new areola in a purse. If
there is dead space or hemostasis is not perfect, we might
consider placement of a suction drain in the pocket at this
stage. The skin and areola approximation is now undertaken
by using interrupted sutures between the dermis of the NAC
and that which is on the skin ap. The right orientation of the
areola should be maintained. This can be achieved by holding the 12, 3, 6, and 9’ o clock position of the areola and skin
aps and marking them. Deep long-lasting interrupted
sutures are now placed to approximate the skin to the areola
(Fig.11.19).
11.4.1.8 Step 7: ‘Cartwheel Suturing’
oftheAreola Using Gortex Thread
Gortex interlocking suture is now used as an alternative to
approximate the two opposing edges. Being a permanent
suture with minimal or no brous reaction, it prevents the
expansion of the areola which is the biggets concern with
such techniques of Mastopexy (Fig.11.20).
11.4.1.9 Step 8: Final Closure oftheSkin
andAreola
After the interlocking suture has been placed and tightened
and the drain xed, skin to skin closure is undertaken using
an absorbable continuous subcuticular suture (Fig. 11.21).
Finally, water proof dressing is done covering the nipple
areola area. The patient is also placed in a support bra which
should be worn by her for 4–6 weeks.
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Fig. 11.15 (a–f) Incision and dissection of the skin subcutaneous ap in all quadrants except in the area where there is dermal attachment for the
NAC
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Fig. 11.16 (a) Marking the midline and the two pillars on the inferior aspect of the breast tissue. (b, c) Incising the marked area using a cautery.
(d) Creating tissue ap for pexy of breast
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Fig. 11.17 (a, b) Coning of the breast by imbricating the medial and lateral pillars. (c, d) The lateral pillar is moved medially to improve the
projection of the breast. (e, f) The nal breast projection achieved by utilizing the extra tissue at the base of the breast
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e
Fig. 11.18 (a, b) Shape of the breast after coning is completed. (c–e) suturing the remnants of the Cooper’s ligament using absorbable sutures
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Fig. 11.19 (a–c) Approximating the skin ap to the NAC at the 12 o Clock position. (d, e) Approximating at the 6’o Clock position
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c
Fig. 11.20 (a–c) Placement of Gortex interlocking “Cartwheel” suture to approximate the areola to the skin and prevent widening of the areola
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Fig. 11.21 (a–d) Final closure of the skin incision after placement of drain (c) using an absorbable subcuticular suture
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11.4.2 Clinical Results ofPeri-Areolar
Mastopexy (Figs.11.22 and11.23)
c d
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Fig. 11.22 A 30-year-old patient who complained of breast deation after pregnancy. She is happy with the breast volume and only wanted her
breast lifted. (a, c) preoperative photographs, (b, d) 1-year postoperative pictures
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Fig. 11.23 42-year-old female patient who just wanted a lift as she did not want any implant in her body, (a, c) preoperative photographs (b, d)
12 months postoperative after Mastopexy
11.4.3 Tips: ForPeri Areolar Mastopexy
withProsthesis
4. If we use prostheses to lift the breast and increase its size,
we should not create a breast cone of the gland
5. Do not insert large and heavy prostheses if the skin is too
Breast prostheses/ implants are used when the volume of the
sagging.
breasts is decient or there is mild breast ptosis with or without sagging skin.
References
1. The shape of the breast is given by the gland, not the skin.
2. The skin is the lining of the new breast shape
3. Coning of the breast tissue and rotation of the mammary
gland with superior or medial pedicle lifts and shaping
the breast
Kotti B. A simple classication and a simplied treatment’s algo-
rithm for ptotic breasts. Plast Aesthet Res. 2018;5:16. https://doi.
org/10.20517/2347- 9264.2018.11.
Spanish Association of Aesthetic Plastic Surgery. Peri-areolar mammo-
plasty, anchor points, Cooper’s ligaments. Plast Surg. 2008;7:9–13.
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