The Limited Incision Periareolar Mastopexy Severely Sacrifices Breast Shape and Aesthetics

Posted on June 21, 2010 in Mastopexy, Nipple-areola complex

A periareolar mastopexy, which is also called a purse string, doughnut (donut) or circumareolar mastopexy, is a technique used for breast lifts that employs just one incision which is situated around the areola. It is inherently attractive to many women who are seeking to rejuvenate and lift their breasts with few tell-tale signs. I feel strongly that a periareolar mastopexy is a rarely indicated approach except for very rare situations involving very minor drooping. The tradeoffs are too high a price to pay in comparison to the far superior results that can be obtained with more and longer incisions.

Unfortunately, many people including physicians have a tendency to equate shorter scars with better, more advanced or state of the art results as well as a more talented surgeon. In situations where the results are exactly the same irrelevant of incision length, such as in gall bladder surgery, this belief can be well founded. However, this isn’t valid in breast lift surgery where I have always believed that if more or longer incisions would allow for an unequivocally superior contour and appearance, then the trade off would be worth it.

The goal of a mastopexy is to recreate a natural, conical shaped breast that has the areola situated at the most projecting part. An inverted-T (or anchor shaped) incision allows for the most precise reshaping of the breast and skin envelope in a three dimensional fashion. It also facilitates the accurate repositioning of the nipple-areola complex on the ideally recontoured and rejuvenated breast.

The limited incision periareolar mastopexy technique eliminates the vertical scar extending down from the areola as well as the horizontal scar in the breast fold. Therefore, essentially a two dimensional approach is expected to solve a three dimensional problem involving lifting and reshaping the breasts, resizing and repositioning the areolas and attempting to obtain improved symmetry. This all has to be performed with the asymmetric removal of a doughnut of excess skin from around the areola and then and purse stringing the larger circle to the smaller circle (areola) which tightens the skin.

This technique creates maximum tension around the areola which then translates into significant untoward and predictable consequences including:
1.)    flattening of the shape of the breast yielding more of a pancake contour rather than a conical one
2.)    a stretched and often flattened areola causing that can be irregular in shape
3.)    widened and thickened scars around the areola
4.)    the appearance of  skin pleats and lines emanating radially outward from the areola
5.)    limited flexibility in the precise placement of the areola on the breast mound
6.)    difficulty obtaining better symmetry of the breasts particularly when they were significantly different in size and or shape prior to surgery

A quite convincing illustration of these issues can be seen in the photos below. This 36 year old woman had a periareolar mastopexy performed by another plastic surgeon and was very unhappy with the outcome on several accounts. She saw me in consultation in order seek correction of her suboptimal results.

This is the outcome of a periareolar mastopexy that was performed by another plastic surgeon. The scars around the areolas are very noticeable, wide and unacceptable. A pleating effect - lines in the skin radiating outwards from the areola - can also be seen.

The scars resulting from the donut mastopexy are prominently visible. The flattening of the areolas as a consequence of the purse string technique is well illustrated in the right breast. Instead of the breasts being perky and somewhat conically shaped, they are flattened and underprojecting.

Very wide and unacceptable scar on the left breast from the periareolar mastopexy

For additional information on breast lift surgery with or without a concomitant breast augmentation or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

When Are Breast Implants Indicated With a Mastopexy?

Posted on May 24, 2010 in Breast Augmentation, Breast Implants, Mastopexy

A mastopexy is the surgical procedure that addresses droopy breasts by tightening the skin, recontouring the shape, and lifting the tissues to create a more youthful appearance. Without the insertion of breast implants, the results may be breasts that are more normal in shape than before but often smaller than expected by the individual which can lead to some disappointment.
When, then, should you consider implants be for your mastopexy? The answer to this is not very difficult most of the time. If you feel that your drooping breasts now are smaller than you would like them to ultimately be, then undergoing a breast augmentation along with the breast lift should allow you to achieve the desired enlarged size. Conversely, if your breasts presently are much larger than you want them to be, there would be no need for implants. Instead, a reduction in size by removing breast tissue would be appropriate.

It is somewhere in between these two “extremes” that determining whether or not to insert breast implants may not be entirely obvious. This decision is also based on the facts that a mastopexy involves the removal of at minimum a small amount of breast tissue and compacts the volume of what remains, most women desire more volume at the upper part of their breasts (a push-up look) and most women would prefer to be a little bigger than a little smaller.

I have found that a vast majority of my patients who undergo a mastopexy also have a concurrent breast augmentation. Even a relatively small breast implant may create a firmer, fuller, rejuvenated appearance with improved cleavage that can be quite alluring.

For more information on a mastopexy, breast augmentation, breast implants or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Breast Reductions Can Be Performed for Cosmetic Reasons

Posted on August 9, 2009 in Breast Reduction, Mastopexy

Breast reductions are most commonly performed for functional reasons, that is, to alleviate symptoms such as neck, back and shoulder pains, headaches and rashes. Even in these situations, there is an aesthetic effect as the smaller breasts will also be lifted and rejuvenated in appearance.

What are some of the reasons to undergo a breast reduction for cosmetic reasons? These can involve situations where the breasts are large but not so gigantic that they would be associated with discomfort but they are bigger than the woman desires or attract unwanted attention or comments. By reducing their size they will be more to the woman’s sought after body image and would be less conspicuous.

Another reason to pursue a breast reduction for aesthetic reasons is where the breasts are both droopy (ptotic) and larger than desired. In this scenario, they are not large enough to cause symptoms or to qualify for insurance coverage. By decreasing their size, tightening the skin envelope and lifting the tissue, smaller, perkier and more youthful appearing breasts can result.

This last scenario can possibly be considered also to be a breast lift (mastopexy) with a small reduction. There can be confusion at times as to what constitutes a breast reduction of which a lift is usually an intrinsic component versus a breast lift with a small reduction. Both procedures usually involve the same incisions. The difference lies in the amount of breast tissue that is removed. Though there is no specific amount that distinguishes between the two, some consider removal of less than 300 grams per side to warrant being called a lift with a small reduction.

Either way, the results are smaller, lifted and perkier breasts.

For additional information on breast reduction surgery, breast lifts or other breast procedure or to schedule a consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona