Mastopexy introduction



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  • superficial fascial system suspension (Lockwood PRS 1999)

    • In the chest, the superficial fascial system splits to form the anterior and posterior fascial layers of the breast



    SKIN INCISION

    The Options are

    1. Augmentation only

    2. Periareolar scar technique

    3. Vertical scar technique

    4. Vertical and short horizontal scar

    5. Vertical and horizontal scar technique (inverted T)

    6. Combinations of above.


    Peri-areolar Incision

    • results in the shortest possible scar pattern

    • elevation of the nipple-areola complex is limited, so that usually only minor degrees of ptosis are addressed with this approach (1-2cm)

    • Spear uses this only Grade 1 ptosis

    • eccentric pattern to maximize elevation of the nipple-areola complex



    • Closure leads to periareolar wrinkling and pleating. This usually resolves over a period of a few months

    • Disadvantages: areolar widening and distortion (30-40% initially)

    • introduction of the purse-string technique with a non-absorbable Gore-Tex suture significantly reduced areolar and scar widening (Benelli round block suture allows the formation of a circular fibrous tissue layer around the nipple-areola complex that prevents spreading of the scar)

    • to minimize tension and wrinkling, it is important to limit the size of the outer diameter to three times that of the inner diameter (Spears)



    Vertical Incision





    • most useful for mild to moderate ptosis- N-IMC distance < 7-8 cm

    • Addition of glandular suspension techniques reduces or eliminates the reliance on the skin envelope for suspension, thereby improving long-term results.

    • The vertical scar techniques provide the most flexibility for augmentation ptosis.




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