Goals/Purpose:
Periareolar augmentation mastopexy is a procedure that has evolved over the last 30 years. In 2007, Dr. Dennis Hammond modified the traditional purse-string approach by adding an interlocking suture that attaches the suture to both the areola and the outer skin. His modification was designed to better distribute the tension across the wound by "locking" the outer purse-string suture with the inner areolar edge in an interlocking pattern. His initial report described 3 patients treated with the interlocking purse string method. Since those initial reports, there has been no large series published to analyze the results of the interlocking technique to examine the result and determine if it improves outcomes. The purpose of this retrospective investigation is to analyze results compiled from 47 consecutive patients who underwent a periareolar mastopexy/augmentation using the interlocking suture technique between March 2009 and December 2011.
Methods/Technique:
A retrospective review was performed on all patients who underwent a periareolar augmentation mastopexy with the interlocking approach between March 2009 and December 2011. Forty-seven patients over this time period were identified for the study, their office and surgical records were reviewed. Of the 47 patients, 30 had both pre-operative and post-operative photographs. These photographs were then analyzed for scar quality and areolar enlargement.
Results/Complications:
All patients were females with grade 2 or 3 ptosis. Forty-seven patients qualified for the study and their office and surgical records were reviewed. The age of the patients ranged from 18 to 61 with the average age being 39. Thirty seven patients underwent primary periareolar augmentation mastopexy and 11 patients were treated with a periareolar mastopexy and implant exchange. The post-operative follow-up periods ranged from less than 1 month to 17 months. The 4 patients who had follow-up periods of less than 1 month were from out of the country and were not seen again after discharge. The overall average follow-up period was approximately 7 months. The implants ranged in size from 125 cc to 550 cc with an average implant size of 316 cc. Pre-operative and post-operative photographs were available for 30 patients and served as the basis for analysis of the areola and scar.
Of the 30 patients who were photographed post-operatively, only one exhibited scar and areola enlargement, ten exhibited scar widening greater than 5mm and three exhibited areola widening alone. One patient exhibited areola shape distortion. The quality of the periareolar scar was analyzed and assigned a rating of "excellent", "good," "fair" or "poor." These rankings were assigned after collaboration and analysis by each of the authors. Ultimately, 12 patients' scars received an "excellent" ranking, 13 received a "good" ranking, 4 received a "fair" ranking and 1 patient's scars received a "poor" ranking. The patient who received a "poor" scar result had an infected Gore-Tex stitch that had to be removed early. This severely affected the quality of her scar on that areola but the quality of the scar on her unaffected areola was "excellent."
There were two complications treated without any need for additional surgery. One patient, a smoker, experienced some epidermolysis of one areola which was treated conservatively. A second patient suffered an allergic dermatitis from an unknown allergen and responded to topical steroids and antihistamines. Four patients required secondary surgery. One patient with a mild eccentric area of one areola required revision under local anesthesia. Two patients developed an infected Gore-Tex suture. In both cases, the suture had to be removed to resolve the infection. A final revision was performed on a patient who wanted larger implants and more lift. This patient was converted to a full mastopexy from the original periareolar mastopexy.
Conclusion:
This study is the largest series of periareolar augmentation mastopexy patients ever reported. It is also the first series of patients treated with Hammond's modified purse-string technique. Eighty-three percent of patients received an excellent or good result while the revision rate was only 13 percent. This review demonstrates that periareolar augmentation mastopexy utilizing an interlocking approach is safe, reliable and produces good cosmetic results. Further studies should be done to compare the results and complication rates of this approach with other techniques used for the periareolar augmentation mastopexy.
Pre-operative Patient 1 Post-operative Mastopexy/Augmentation (330 cc Saline Implants) Patient 1
Pre-operative Patient 2 Post-operatative Mastopexy/Augmentation (390cc Saline Implants) Patient 2
Pre-operative Patient 3 Post-operative Mastopexy/Augmentation (371cc Saline Implants) Patient 3
Pre-operative Patient 4 Post-operative Mastopexy/Augmentation (330cc Saline Implants) Patient 4