Goals/Purpose:
Initial surgical incisions are frequently designed to be as short as possible and linear. W- or Z-Plasties can be used to improve suboptimal results by lengthening scar and disrupting linearity to reduce detection. We theorized that the proactive maximization of length and minimization of linearity could provide better camouflage than traditional straight incisions. We designed and tested our hypothesis that non-geometric, irregular incisions produce aesthetically superior scars in the inherently ill-defined textural- and pigmented border of the areola.
Methods/Technique:
The 'irregularly irregular incision' technique was applied in 40 instances of periareolar mastopexy in 21 consecutive patients over 14 months in the practice of a single senior surgeon. Periareolar marks were made (Fig. 1) and non-distorting volumes of lidocaine with epinephrine were then infiltrated along the markings using 30 gauge needles. Upon full vaso-constriction, number 11 standard or Alcon blades were used to create highly irregular incisions with frequently-shifting directional vectors, numerous contiguous segments of varying lengths, and with vector angles that ranged from 0 to 180 degrees (Fig. 2). If necessary, hemostasis was achieved with low-power cautery (setting of 12). Minor areolar undermining preceded a 2- or 3-layered closure which always included interrupted, buried, mid-dermal sutures of 6-0 clear Prolene. Suture removal occurred on the second or third day, and mastisol and Steri-strips were applied.
Results/Complications:
Scars were followed for a minimum of 18 months and showed excellent camouflage. No scar contracture was seen. Approximately 20% of final scars were nearly undetectable (Fig. 3-5). 2 of 40 incisions (5%) required revision following partial wound disruption, but were successfully improved using the same technique.
Conclusion:
Proactive periareolar use of irregularly irregular incisions yields excellent outcomes with a low revision rate. This novel technique has also become the standard incision for many other anatomic locations at our institution.
