Procedure
New semicircular method (Fig. step three ) is basically a comparable techniques while the one revealed because of the Webster in the 1946 seven for gynecomastia. A sufficient amount of glandular tissue might be remaining in the situ under the NAC to get rid of a despair. This benefit of this technique is the smaller than average better-hidden scar that is confined so you can (the lower half) the fresh new nipple-areola state-of-the-art. The top downside is the small windows by which to focus, making excision off breast cells and you can hemostasis more complicated.
In the instances of less chest that have highest preferred hard nipples, this new transareolar technique (Fig. cuatro ) is employed. This is exactly much like the processes demonstrated by Pitanguy into the 1966 8 and you may allows for subtotal resection and instantaneous decrease in the new nipple. This new resulting mark traverses the fresh new areola horizontally and you can passes in the upper aspect of the breast.
Brand new concentric round strategy (Fig. 5 ) is much like one to discussed because of the Davidson into the 1979. nine It is useful breasts with a method-size of facial skin envelope (B mug), or in your situation regarding shorter bust having poor body suppleness. The fresh new resulting scar could well be restricted to your width of areola. This new concentric incision is going to be pulled since a group or ellipse, providing deepithelialization out of a calculated number of facial skin on the vertical or lateral recommendations. cuatro , 5 Availableness was achieved through a cut in the inferior element of external system leaving a wide pedicle toward NAC. A purse-sequence suture is positioned and place to the desired areolar diameter (usually twenty five–30 mm). The advantage of this technique would be the fact it permits to own protection and/or repositioning of areola, in which requisite, and also for the elimination of excessively facial skin.
The newest longer concentric round techniques (Fig. six ) is a lot like the https://datingmentor.org/cs/snapsext-recenze/ new concentric round techniques, but is sold with a couple of additional triangular excisions of facial skin and you will subcutaneous muscle horizontal and you may/ otherwise medial. This method is useful for repairing surface way too much and wrinkling produced from the higher differences between the interior and you can exterior sectors. The fresh ensuing markings was inside the areola, that have lateral extensions onto the breast facial skin, according to standard of excessively epidermis.
The brand new totally free nipple graft techniques (Fig. eight ) has been recommended by a number of experts having people that have higher and you may ptotic chest. 2 , step 3 , 10 , 11 , twelve It include picking the brand new NAC because the a complete-thickness surface graft; amputating the nipple; and you will grafting this new NAC onto the the fresh venue towards the chest wall. Our very own liking will be to put the incision horizontally 1 to 2 cm above the inframammary flex, following to go up laterally below the lateral border of the newest pectoralis biggest muscle mass. New keeping the fresh new NAC always represents this new 4th otherwise fifth intercostal area. Medical wisdom are most crucial, however, and we always stay the average person up intraoperatively to check latest nipple standing. The many benefits of this new free nipple graft approach try easy breasts contouring, advanced coverage and more fast resection away from tissue, as well as breast cures, areola resizing, and you can repositioning. This new downsides are the long recurring scars, NAC pigmentary and you may sensory transform, and also the chances of unfinished graft take.
Complications
Postoperative problem become hematoma (common, even after drainage and you can compressing bandages), (partial) nipple necrosis, and you will abscess formation. Which underscores the necessity of achieving a good hemostasis intraoperatively. Quicker hematomas and you can seromas might be exhausted as a consequence of puncture, but for big collections surgical evacuation is needed.
Several other maybe not rare complication include skin slough of the NAC, which can be remaining so you can restore by conventional means. The fresh exceptional cases of partial or total breast necrosis might require a vacation breast reconstruction. Inside new customers instead of problem,