Procedure
Brand new semicircular technique (Fig. step 3 ) is essentially the same processes because the you to definitely described because of the Webster inside the 1946 eight having gynecomastia. A sufficient amount of glandular cells might be kept into the situ beneath the NAC to cease an anxiety. The benefit of this technique is the smaller than average really-undetectable mark that is restricted in order to (the reduced half of) the brand new breast-areola cutting-edge. The major downside ‘s the small screen by which be effective, and work out excision of nipple tissue and hemostasis more difficult.
Inside cases of quicker tits which have large well-known erect nipples, the fresh new transareolar approach (Fig. 4 ) is used. This is exactly just as the techniques discussed by Pitanguy into the 1966 8 and enables subtotal resection and you may instant reduced total of the brand new breast. This new ensuing mark traverses the new areola horizontally and you can entry within higher aspect of the nipple.
The new concentric round method (Fig. 5 ) is similar to one explained because of the Davidson during the 1979. 9 It’s used in chest having an average-size of epidermis envelope (B 
cup), or perhaps in happening away from less boobs with worst epidermis suppleness. The latest resulting mark will be confined towards width of the areola. The fresh new concentric incision should be taken since a circle otherwise ellipse, providing deepithelialization regarding a calculated quantity of facial skin from the straight or lateral recommendations. 4 , 5 Access was gained thru a cut on the second-rate factor of your own outer system leaving a wide pedicle for the NAC. A handbag-sequence suture is put and put to your need areolar diameter (constantly twenty-five–31 mm). The advantage of this technique is that it permits getting reduction and/otherwise repositioning of areola, where expected, and also for the removal of excessively surface.
This new stretched concentric game strategy (Fig. 6 ) is much like the fresh new concentric round approach, but is sold with two a lot more triangular excisions from skin and you can subcutaneous structure horizontal and you will/ or medial. This technique will work for correcting body too-much and wrinkling brought by the highest differences when considering the interior and outer groups. The new ensuing scars might possibly be around the areola, which have lateral extensions onto the breast surface, according to degree of excessive body.
The free breast graft techniques (Fig. eight ) might have been advised by several people to possess clients which have higher and you will ptotic boobs. 2 , step 3 , 10 , eleven , several It consists of picking this new NAC once the a full-occurrence body graft; amputating the fresh breast; and you may grafting the newest NAC onto their the fresh area for the chest wall. Our very own taste will be to put the incision horizontally 1 to 2 cm above the inframammary bend, then to maneuver right up sideways underneath the horizontal edging away from the newest pectoralis significant strength. The new keeping this new NAC always corresponds to the fresh last or fifth intercostal space. Health-related wisdom are foremost, not, and now we constantly stay the person upwards intraoperatively to evaluate latest nipple reputation. The many benefits of the fresh 100 % free breast graft approach try easy breasts contouring, higher level exposure and fast resection from structure, including breast prevention, areola resizing, and you will repositioning. The latest downsides is the a lot of time residual scars, NAC pigmentary and you can neurological alter, and the possibility of incomplete graft simply take.
Difficulty
Postoperative difficulty are hematoma (most frequent, even with drainage and you will compression bandages), (partial) nipple necrosis, and you will abscess creation. This underscores the significance of reaching an excellent hemostasis intraoperatively. Shorter hematomas and you can seromas are exhausted owing to puncture, however for big series surgical evacuation required.
Some other perhaps not rare effect includes skin slough of your NAC, which will be leftover to repair by the traditional mode. The fresh new exceptional cases of partial otherwise overall nipple necrosis might require a holiday breast reconstruction. Even in the fresh people instead difficulty,