02. Trans-hemi-periareolar access in additive mastoplasty
KEYWORDS: additive mastoplasty, surgical access, mammary prosthesis
Additive mastoplasty is carried out under assisted local anaesthesia. The mammary gland is infiltrated with the anaesthetic solution. To insert the prosthesis, we use a new surgical access that is particularly suitable for breasts that have a large areola. This access has the advantages of being inconspicuous and of providing very good protection for the prosthesis. The superficial hemi-areolar incision runs close to the inferior edge of the nipple. A flap is then dissected in the inferior half of the areola. This superficial areolar flap is then lifted up to the inferior edge of the areola. Dissection is started with a scalpel and completed with scissors. Having reached the inferior margin of areola, the operator incises the gland to reach the muscle fascia and creates the pocket in which the prosthesis is to be lodged. Once haemostasis has been obtained, the mammary prosthesis is inserted; this can be done without difficulty. The gland is now sutured with absorbable threads. The gland is sutured at the level of the lower edge of the areola. On completion of the glandular suture, the skin flap is sutured. The hemi-areolar skin flap suture is offset in relation to the deep glandular suture. The skin suture is not under tension, the prosthesis is adequately protected and the stitches can be removed within a short time. The result is excellent; after only one month, the scar is hardly visible.
Trans-hemi-periareolar access in additive mastoplasty
When should this new access be used?
We use this access in large areolae that have a fairly uniform surface, as the hemi-areolar incision is inconspicuous.
What precautions should be taken when using the trans-hemi-periareolar access?
The skin flap has to be handled delicately.
What other advantages does this new access have, apart from the fact that the scar is hardly visible?
The skin access and the glandular access are not in the same vertical plane, but are offset. This offers greater protection for the prosthetic cavity against possible infection, and there is no scar retraction.
This particular surgical access proves useful only in patients with large areolae. If the procedure is performed delicately, the residual scar will be much less visible than a periareolar scar.