Author Topic: Breast Reduction Circular Scar- only Method Published on Line Feb 2011  (Read 5323 times)

Dr. Donn Hickman

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Summary of article:   An American Series of Purse String Circular Scar (periareolar) method for breast reduction which follows the method Of Brazilian pioneer Dr. Sampaio-Goes.  No vertical or horizontal scarring.   

Periareolar reduction mammaplasty is usually restricted to smaller hypertrophies with
minimal ptosis. The purpose of this report is to examine the Goes double-skin periareolar
approach without mesh, in challenging bilateral and unilateral hypertrophies with major ptosis,
including patients who are older, endomorphic, have thin elastic skin, or previously operated
asymmetry.

45 patients (37 bilateral and 8 unilateral) underwent a circumareolar skin excision based on 4
geometric chest landmarks, superior anterior tissue resection, central-type pedicle, vertical cone
assembly, areolar fixation, telescoping of an outer circular breast flap onto an inner areolar
circle, and permanent circlage suture. The unilateral group included: 4 reductions opposite to a
mastectomy reconstruction, and 4 reductions with contralateral mastopexy, plus bilateral implant
change in the previously augmented patient.

Average nipple elevation/resection was 7.2 cm/285 gm for bilateral reduction, 7.4 cm/291 gm for
unilateral reduction without implants, and 6.4 cm /131 gm for unilateral reduction with implants.

There were 4 significant complications (4.8%) in 82 breasts. In the bilateral group, there was a dermal
cyst, dermal abscess, and scar granuloma. In the unilateral group, there was a 50% areolar necrosis
and poor scarring in a reduced breast on a previously augmented patient from outside. It was learned
after surgery that tissue resections were done at the original augmentation. Minor complications
occurred in 14 breasts (14.6%).

Average case follow-up (bilateral/unilateral ) was 2 years/9 months.
As the plastic surgeon is reminded of principles, periareolar reduction mammaplasty can be
applied within reason to a broad group of patients with good satisfaction. Breast reduction in
previously operated patients with breast asymmetry and implants should place the surgeon on guard.