Processes
The fresh new semicircular method (Fig. 3 ) is largely an equivalent procedure because you to definitely revealed by Webster during the 1946 eight to have gynecomastia. A sufficient amount of glandular tissues can be leftover for the situ under the NAC to quit an anxiety. The specific advantage of this method is the smaller than average well-undetectable scar that is restricted in order to (the low 1 / 2 of) the newest breast-areola complex. The big disadvantage is the short windows through which to get results, while making excision from breast muscle and you may hemostasis much harder.
Inside cases of shorter breasts having highest common erect nipples, this new transareolar technique (Fig. cuatro ) is utilized. That is just like the processes demonstrated by the Pitanguy within the 1966 8 and allows for subtotal resection and instant decrease in the brand new nipple 
. The ensuing scar traverses brand new areola horizontally and you may tickets around the top aspect of the nipple.
The brand new concentric circular approach (Fig. 5 ) is a lot like one to discussed because of the Davidson during the 1979. 9 It is utilized for bust that have a media-sized skin package (B glass), or perhaps in happening out of quicker bust having bad surface suppleness. The latest resulting mark might possibly be confined into circumference of your own areola. The fresh concentric cut will likely be taken since a group otherwise ellipse, enabling deepithelialization away from a determined quantity of body regarding vertical or lateral guidance. 4 , 5 Accessibility is attained through a cut throughout the inferior element of your own external system making an extensive pedicle on the NAC. A bag-string suture is placed and place towards desired areolar diameter (always twenty five–29 mm). The advantage of this technique is the fact it allows having avoidance and/or repositioning of your own areola, in which needed, and for the removal of way too much skin.
The longer concentric circular technique (Fig. six ) is a lot like the fresh concentric rounded techniques, but includes a couple a lot more triangular excisions out of facial skin and subcutaneous tissues horizontal and you can/ otherwise medial. This process is useful for correcting epidermis excessively and you can wrinkling produced by highest differences between the interior and outside circles. The fresh ensuing marks was within the areola, which have horizontal extensions on the breast surface, with respect to the standard of too-much skin.
This new totally free breast graft method (Fig. eight ) has been proposed by several article authors to own clients having higher and you may ptotic bust. 2 , step 3 , 10 , eleven , a dozen They includes picking the newest NAC as an entire-occurrence surface graft; amputating the new nipple; and you will grafting this new NAC on to their the new location into boobs wall. Our liking is to place the cut horizontally 1 to 2 cm above the inframammary flex, after which to maneuver up sideways beneath the horizontal border of this new pectoralis biggest muscle mass. This new placement of brand new NAC usually represents new 4th or fifth intercostal room. Systematic wisdom was most important, however, and now we constantly stay the individual up intraoperatively to check on final breast reputation. The key benefits of the free breast graft technique try effortless tits contouring, advanced publicity and a lot more rapid resection from tissues, in addition to nipple avoidance, areola resizing, and you may repositioning. New drawbacks certainly are the a lot of time residual marks, NAC pigmentary and you may neurological changes, and the odds of partial graft simply take.
Issue
Postoperative issue were hematoma (most commonly known, even after drainage and you will compression bandages), (partial) nipple necrosis, and you can abscess formation. Which underscores the significance of achieving a beneficial hemostasis intraoperatively. Shorter hematomas and you will seromas will be exhausted courtesy puncture, but also for huge stuff medical evacuation needs.
Other not infrequent side effects consists of facial skin slough of NAC, which can be leftover to restore by old-fashioned mode. The latest exceptional cases of limited otherwise full nipple necrosis might require a holiday breast reconstruction. Inside brand new people in the place of problem,
