Double Purse String Closure Technique for Minimizing Post-Operative Widening of Periareolar Augmentation Mastopexy: A Comparative Study | ||||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
| Article 5, Volume 43, Issue 3, October 2020, Page 375-381 PDF (15.82 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejprs.2020.68160 | ||||
 View on SCiNiTO | ||||
| Author | ||||
| Nahed S Boughdadi* | ||||
| The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||||
| Abstract | ||||
| Objectives: For management of mild degree breast ptosis periareolar mastopexy had been commonly used. Since Benelli 1990 had confined the scar to the areola in his round-block technique, several authors has adopted this technique. Whether mastopexy had been done with or without augmentation, the problems of breast shape, areolar irregularities,and stretch of the areola had been annoying to both patients and surgeons. These problems also represent a major challenge to this technique. In this paper purse string closure was used in two consecutive different layers one in dermal de-epithelized layer and another in the deep dermis of the skin. The aim is to minimize widening of scars of peri-areolar incision and improve its long term appearance. Patients and Methods: 50 cases underwent mastopexy with breast augmentation. Cases were divided into two groups: Group A: Underwent closure by single purse string layer and Group B: Two consecutive purse string closure. The second concentric row was applied to the deep dermal plane of the normal non de-epthelialized skin similar to the classical purse string closure described previously. Both subjective and objective evaluation were done. Surgery was done by single surgeon and two surgeons not involved in research evaluated the post-operative photos. Follow-up was done at 3, 6 month and at 1 year post-operative. Results: Group B patients showed superior results as regarding breast shape, contour, projection, superior fullness, periareolar scar shape, regularity, areola width and position. These results were followed-up for one year. Conclusion: Decreasing the tension of the periareolar suture by applying double purse string technique in two different planes improved long term results of periareolar scar in order to avoid widening, irregularities and hypertrophic scarring. | ||||
| Keywords | ||||
| Breast ptosis – Periareolar – Mastopexy – Augmentation | ||||
| References | ||||
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1- Regnault P.: Breast ptosis: Definition and treatment. Clin. Plast. Surg., 3: 193-203, 1976. 2- Brink R.R.: Management of true ptosis of the breast. Plast. Reconstr. Surg., 91: 657-62, 1993. 3- Spear S.L., Boehmler J.H. 4th and Clemens M.W.: Augmentation/ mastopexy: A 3-year review of a single surgeon's practice. Plast. Reconstr. Surg., 118: 136S-47S, 2006. 4- Hoffman S.: Some thoughts on augmentation/mastopexy and medical malpractice. Plast. Reconstr. Surg., 113: 1892-3, 2004. 5- Nahai F., Fisher J., Maxwell P.G. and Mills D.C. II: Augmentation mastopexy: To stage or not. Aesthet. Surg. J., 27: 297-305, 2007. 6- Spear S.L. and Giese S.Y.: Simultaneous breast augmentation and mastopexy. Aesthet. Surg. J., 20: 155-63, 2000. 7- Spear S.L., Pelletiere C.V. and Menon N.: One-stage augmentation combined with mastopexy: Aesthetic results and patient satisfaction. Aesthetic Plast. Surg., 28: 259- 67, 2004. 8- Gallent I.M., Pons M.R. and Drever M.: Vertical scar mastopexy with an implant. Aesthetic Plast. Surg., 27: 406-10, 2003. 9- Karnes J., Morrison W., Salisbury M., Schaeferle M., Beckham P. and Ersek R.A.: Simultaneous breast augmentation and lift. Aesthetic Plast. Surg., 24: 148-54, 2000. 10- Stevens W.G., Stoker D.A., Freeman M.E., Quardt S.M., Hirsch E.M. and Cohen R.: Is one-stage breast augmentation with mastopexy safe and effective? A review of 186 primary cases. Aesthet. Surg. J., 26: 674-81, 2006. 11- Stevens W.G., Freeman E.M., Stoker D.A., Quardt S.M., Cohen R. and Hirsch E.M.: One-stage mastopexy with breast augmentation: A review of 321 patients. Plast. Reconstr. Surg., 120: 1674-9, 2007. 12- Tessone A., Millet E., Weissman O., et al.: Evading a surgical pitfall: Mastopexy-augmentation made simple. Aesthetic Plast., 2011. 13- Bartels R.J., Strickland D.M. and Douglas W.M.: A new mastopexy operation for mild to moderate ptosis. Plast. Reconstr. Surg., 57: 687, 1976. 14- Erol O.O. and Spira M.: A mastopexy technique for mild to moderate ptosis. Plast. Reconstr. Surg., 65: 603, 1980. 15- Benelli L.: A new periareolar mammaplasty: Round block technique. Aesth. Plast. Surg., 14: 99, 1990. 16- Sampaio-Goes J.C.: Periareolar mammaplasty with mixed mesh support: The double skin technique. Proceedings of the Eighth International Congress on Breast Diseases and Senology. Rio De Janeiro, Brazil, May 8e12, 1994. 17- Gonzalez R.M.D.: The PAM method-periareolar augmentation mastopexy: A personal approach to treat hypoplastic breat with Moderate Ptosis Aesthetic Journal, 32 (2): 175- 85, 2012. 18- Hall-Findlay E.J.: Pedicles in vertical breast reduction andmastopexy. Clin. Plast. Surg., 29: 379-91, 2002. 19- Hammond D.C., Alfonso D. and Khuthaila D.K.: Mastopexy using the short scar periareolar inferior pedicle reduction technique. Plast. Reconstr. Surg., 121: 1533-9, 2008. 20- Bass C.D.: Herniated areolar complex. Ann. Plast. Surg., 1 (4): 402, 1978. 21- Gruber R.P. and Jones H.W.: The donut mastopexy indications and complications. Plast. Reconstructive Surg., 65: 34, 1980. 22- Felicio Y.: Periareolar reduction mammoplasty. Plast. Reconstructive Surg., 88: 1789. 23- Hidalgo D.A. and Spector J.A.: Mastopexy. Plast. Reconstr. Surg., 132: 642e-656e, 2013. 24- Jade Chapman and Scott Ingram: The gortex suture in periareolar closure: A modified closure technique aesthetic Plast. Surg., 0696-8, 2016. 25- Donn M. Hickman: Application of Goes double-skin periareolar mastopexy with and without implants a 14- years experience Journal of Plastic and Reconstructive Surgery, 64: 164-73, 2011. 26- Gryskiewicz J.M. and Agnieszka S. Hatfield, M.D.: Zigzag wavy-line periareolar incision, Vol., 110, 7, 2001 | ||||
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