AUGMENTATION MAMMAPLASTY USING A NON-INFLATABLE PROSTHESIS THROUGH A CIRCUM-AREOLAR INCISION

By PETER MCKINNEY, M.D. Assistant Professor of Surgery (Plastic), Northwestern Universit-v, Attending Surgeon, Chicago

Wesley Memorial Hospital

and A. USHIED SHEDBALKER, M.D. Senior Resident, Chicago Wesley Memorial Hospital, Division of Plastic Surgery, Northwestern University, Searle Building-Room 13-535, 303 East Chicago Avenue, Chicago, Illinois 6061 x

A DESIRE to conceal the scars left by augmentation mammaplasty has encouraged plastic surgeons to seek incisions other than the conventional inframammary ones. Although an incision 2 to 3 cm. above the inframammary fold or one at the lower lateral border of the breast can be hidden by ordinary clothing, the degree of scarring is unpredictable.

A peri-areolar incision has been the standard approach for many years in milder cases of gynaecomastia (Dufourmentel, 1928) and the virtually invisible scars which result are well known. Increasingly it is being used to insert inflatable prostheses for augmentation (Williams, 1972). We have also found it adequate for the insertion of preformed non-inflatable prostheses.

FIG. I. The half-circle circumareolar incision line which measured 5.5 cm. on compressing the breast. The functional length when cut was 9’5 cm.

FIG. 2. Exposure and size of the retromammary pocket.

TECHNIQUE

A curved line is marked along the areolar border from 3 to 9 o’clock. An assistant compresses the breast against the chest wall (Fig. I), thus stretching the areola and the surrounding skin. The incision is carried through the subcutaneous fat and then slanted to glide over the mammary glandular tissue to the periphery, a distance of about 4 cm.

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FIG. 3. Procedure completed. 195 g. Ashley prostheses used. Wounds closed with subcuticular suture.

FIG. 4. 4 and B, Half circle circumareolar measurement 4 cm. minimal mammary tissue operanve photographs.

Pre- C and D, One month post-operative. Prostheses used: 120 g. Ash&.

AUGMENTATION MAMMAPLASTY USING A NON-INFLATABLE PROSTHESIS 37

This effectively bevels the incision and permits a better closure of the wound. Dissection is then carried through the glandular tissue. A retromammary pocket is created by blunt and sharp dissection under direct vision. This facilitates accurate haemostasis (Fig. 2). The selection of the proper size of the prosthesis is made at the pre-operative consultation, but it can be checked with the use of Cronin sizers.’ After insertion of the prosthesis (Ashley prostheses2 are preferred by the authors for other reasons), closure is performed by approximating the mammary tissue and the fatty subcutaneous layers

FIG. 5. A and B, Pre-operative photographs. Slightly ptotic breast. C and D, Three months . . .w.. . post-Operatively. IgO g. prostheses USeCi. Mlnlmal scar.

separately, using 3/o “Dexon”. The circumareolar incision is closed by a subcutic:ular pull-out suture which is left in place for 2 weeks (Fig. 3).

This technique has the following advantages: The scar is aesthetically more pleasing, owing to its fading and merging with the

normal pigmented areola. The incision is in the centre of the field. Dissection and haemostasis are therefore

easier under direct vision. In some patients, a functional incision of nearly IO cm. is obtained, even though a

half-circle measurement of the periphery of the areola at rest may only measure 5.5 cm.; 1 Manufactured by Dow Corning Company, Midland, Michigan. 2 Manufactured by Ed Week and Company, Long Island City, New York.

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the length of the incision may therefore be comparable to that of a conventional inframam- mary incision. Two of the cases are illustrated in Figures 4 and 5.

DISCUSSION

Four patients have undergone augmentation mammaplasty with this technique. Two of them had half-circle circumareolar measurements of 4 cm. which expanded to 5.5 cm. with dissection and retraction of the wound edges. In one of these patients, 120 g. Ashley prostheses were used, and in the other, 160 g. Ashley prostheses. The latter needed a short extension of the incision. The half-circle measurements in the remaining 2 patients were 5.5 and 8 cm. respectively. On compression of the breast against the chest wall, functional incisions in each case were about 9.5 cm. Each of the last 2 patients received 195 g. Ashley prostheses. In the patient with the 8 cm. half- circle at rest, 225 g. Ashley prostheses could be introduced easily, but the smaller prostheses were selected for use. One patient complained of persistent numbness of her right nipple which has not cleared 2 years after surgery, and this may be a potential disadvantage of this approach.

SUMMARY

A technique for augmentation mammaplasty with non-inflatable prostheses through a circumareolar incision is described. It has been successful thus far for 4 patients, and offers predictably less scarring. The question as to whether this approach has a greater hazard of nipple paraesthesia is raised.

REFERENCES

DUFOURMENTEL, L. (1972). l’incision arkolaire dans la chirurgie du sein. Bulletin et Mdmm’res de la SocielB Chirurgicale de Paris, 20, g-14.

WILLIAMS, J. E. (1972). Experiences with a large series of Silastic breast implants. Plastic and Reconstructive Surgery, 49, 253-258.