Nipple-sparing mastectomy through periareolar incision with immediate reconstruction

PURPOSE: Nipple-sparing mastectomy (NSM) has become increasingly popular due to improved cosmesis without compromising oncologic safety. Radial and inframammary incisions are usually used to achieve NSM, with periareolar incisions usually being avoided because of the risk to nipple-areola complex viability. In an attempt to maximize esthetic effects, we performed NSM through periareolar incision with immediate reconstruction. We report our initial experience.METHODS: This case series consisted of all consecutive patients (n = 34) who underwent NSM through a periareolar incision in our institution between August 2017 and December 2018. All patients underwent NSM through periareolar incision followed by immediate reconstruction with an implant or deep inferior epigastric perforator flap. Patient demographics, tumor and treatment characteristics, and short-term postoperative outcomes were reviewed.RESULTS: The mean patient age was 46.74 ± 6.69 years (range, 38–62 years), and the mean operation time was 96.68 ± 28.00 minutes. Indications included in situ cancer in 12 cases and invasive cancer in 22 cases. There was 1 major complication (postoperative hematoma) requiring operative reintervention. No other complications including fistula, implant exposure, or reconstruction failure was observed. At the time of writing, no case of local recurrence has been observed.CONCLUSION: Our initial report shows that NSM with immediate reconstruction may successfully be performed through periareolar incision. This method maximizes esthetic effects and may be an appropriate surgical option for NSM.

A prospective study of scars after breast implantation with different incisions / 中华整形外科杂志

Objective@#To compare the scar condition after breast implantation with axillary, periareolar and inframammary fold (IMF) incisions.@*Methods@#The consecutive patients who were diagnosed as breast hypoplasia and underwent breast implantation surgeries between May 2012 to December 2014 were included in the research. The scars were assessed at 1, 6 and 12 months after surgery with VSS and patient satisfaction scoring. The results were analyzed with Variance and Kruskal-Wallis test based on the data type.@*Results@#The scars of 173 patients were assessed 3 times with the follow-up rate being 82.4%. The VSS scores of every incision declined with time, and the patient satisfaction scores increased gradually. At one month after surgery, the media VSS scores were 6 in axillary group and 4 in periareolar and IMF groups, the differences had statistical significance (P<0.05). The media scores of patients satisfaction were 8 in periareolar group and 7 in axillary and IMF groups. The scores of periareola group were higher than those of axillary with statistical significance(P<0.05). When 6 months after surgery, the media VSS scores were 4 in axillary group and 3 in periareolar and IMF groups. The scores of axillary group were higher than those of IMF with statistical significance(P<0.05). The media scores of patients satisfaction were 8 in 3 groups. When 12 months after surgery, the media VSS scores were 0.5 and 1 in periareolar group (left and right respectively), and 2 in axillary and IMF groups. The media scores of patients satisfaction were 9 in 3 groups. No differences were found in VSS and patients satisfaction scores among three kinds of incisions (P>0.05).@*Conclusions@#The scars of three incisions achieved similar cosmetic effects and patient satisfaction at long-time follow-up.

Tratamiento de la ginecomastia: Diferencias entre la incisión periareolar externa y la incisión periareolar inferior en mastectomía subdérmica / Treatment for gynecomastia: Differences for the external and inferior periareolar incision for subdermal mastectomy

Introducción: La ginecomastia define el aumento benigno del tamaño de la glándula mamaria en el hombre. Existen diversos abordajes quirúrgicos para la resección de la lesión, cada una con resultados diferentes. Material y métodos; Estudio transversal. Se incluyeron pacientes con ginecomastia operados de mastectomía subdérmica mediante incisión periareolar externa e incisión periareolar inferior. Para la aleatorización se tomó en cuenta los grados IIb y III de Simon, distribuyendo uno a uno para cada tipo de incisión. Los resultados estéticos fueron evaluados por un cirujano experimentado, tomando como excelentes cuando hubo una cicatrización correcta sin deformidad del área, buenos cuando la cicatrización fue buena sin deformidad del área y mala cuando hubo deformidad del área operada. Resultados: Fueron operados 24 pacientes, el 50% por incisión periareolar externa y el 50% por incisión periareolar inferior. La edad promedio fue 25,58 y 27,58 años respectivamente, sin diferencias significativas p = 0,513. Todos los pacientes tuvieron características sexuales secundarias normales. La etiología fue idiopática en 23 pacientes (95,83%). El tiempo promedio de evolución fue 32,28 meses y en todos el resultado histopatológico fue ginecomastia. La evaluación del aspecto estético de la incisión y el área afectada en los pacientes operados mediante incisión periareolar externa (n = 12) fue mala en un paciente (8,33%), buena en 2 (16,66%) y excelente en 9 pacientes (75%), mientras que en los pacientes operados mediante incisión periareolar inferior, fue buena en el 100% de los pacientes, y mala y excelente en ningún paciente, con diferencias estadísticamente significativas para ambas incisiones, p = 0,000. Ningún paciente presentó complicaciones. Conclusión: Ambas incisiones son seguras. La incisión periareolar externa ofrece mejores resultados que la incisión periareolar inferior para realizar mastectomía subdérmica en pacientes con ginecomastia en todos los grados Simon.

Introduction: Gynecomastia defines the benign enlargement of the mammary gland in man. There are several surgical approaches for resection of the lesion, each with different results. Material and methods: Cross-sectional study. There were included patients with gynecomastia, operated by means of external and inferior periareolar incision. For randomization was took into account degrees IIb and III of Simon, distributing one to one for each type of incision, the cosmetic results were evaluated by an experienced surgeon, taking as excellent results when there was a proper healing without deformity of the area, good results when healing was good without deformity, and bad results when there was deformity of the operated area. Results: There were 24 patients, 50% operated by external periareolar incision and 50% by lower periareolar incision. The mean age was 25.58 and 27.58 years old for each group, with no significant statistically differences (P = .513). All patients had normal secondary sexual characteristics. The etiology was idiopathic in 23 (95.83%). The average evolution time was 32.28 months, on all histopathological result was gynecomastia. The evaluation of the aesthetic aspect of the incision and the area affected in patients operated by external periareolar incision (n = 12) was bad to 1 (8.33%), good in 2 (16.66%) and excellent in 9 (75%) patients; 100% of the patients operated by inferior periareolar incision presented good results, there were statistically significant differences for both incisions, P = .000. There were no complications. Conclusion: Both incisions are safe, periareolar external incision provides better results than the inferior periareolar incision for patients with gynecomastia in all degrees of Simon.

Aesthetic effect of removing multiple fibroadenomas of breast with periareolar incision / 中华医学美学美容杂志

Objective To explore the methods and significance of section of multiple fibroadeno mas of breast with better incision.Methods From may 2005 to December 2014,21 cases were per formed by removing multiple fibroadenomas of breast with a new incision.Preoperatively,the diag nostic work-up included clinical examination,breast ultrasonography and/or mammography.A new approach,for removing of multiple fibroadenomas of the breast with the incision in periareolar site,was used in our hospital.All palpable breast lumps were excised with this approach through which the fibroadenomas were removed as a whole unit.Then,the breast cavity were irrigated with normal saline solution,and strict haemostasis of the bed was done by electrocautery.If the resulted cavity was larger,interrupted sutures should be performed with the absorbable stitches;otherwise,it was unnecessary.The skin wound was sutured to the deepithelialized area with Vicryl 5-0 (Ethicon).Results There were 21 cases,who underwent surgery using the described technique through which 95 lumps (0.5 cm× 0.5 cm-6.0 cm× 5.0 cm) were removed and included in the study.All patients' resected tumor specimens were pathologically confirmed as fibroadenoma.No major complications were encountered in any of the patients.The incision was well concealed by the dome of the nipple and the areolar pigmented and corrugated skin.Both doctors and patients were satisfied with postoperative aesthetic effect of the incision scar.Conclusions The incision in periareolar site for excision of multiple fibroadenomatas results in minimal scarring and a better appearance than that can be achieved with traditional methods.This technique,which can improve the aesthetic outcome of breast surgery,should be performed when feasible.

Treatment for Gynaecomastia in Men. Experience with the Inferior Periareolar Incision in a Single Third Level Medical Facility.

Background: Gynaecomastia is defined as an enlargement of the mammary gland in men. Objective: To evaluate Aesthetic Results of Subdermal Mastectomy by means of Inferior Periareolar Incision. Materials and Methods: Descriptive, cross sectional and prospective study. We evaluate aesthetic results of Subdermal Mastectomy by means of Inferior Periareolar Incision using Analog visual Scale applied by an another Surgeon) and a Questionnaire (Auto Evaluation). Variables: Age, Clinical Symptoms, Evolution time, Complications and Aesthetic Results. Descriptive and Inferencial Statistic was used (Wilcoxon test). Results: Twelve patients, median age 27.5 (18-58) year-old. Nine (75%) patients presented pain, 4 (33.3%) bilateral gynaecomastia, 4 (33.3%) left and 4 (33.3%) right sided gynaecomastia. According to Simon Classification, 3 (25%) patients grade I; 2 (16.6%) IIa; 2 (16.6%) IIb and 5 (41.6%) III. No patient presented concomitant disease, 12 (100%) had normal secondary sexual characteristics. Six (50%) had hyperesthesia. The Aesthetic Evaluation made by a distinct Surgeon was as it follows, 10 (83.3%) had a ≤ 6 punctuation and 2 (16.6%) had ≥ seven (0 - 10, Analogue Visual Scale). Ranks for Aesthetic Aspect Evaluation made by the patients, before and after surgery were 2.54 (average after surgery) and 0.00 (average before surgery), Z -1.857, p=0.0063 (p<0.05, Wilcoxon). Conclusion: Subdermal Mastectomy should be in lower case by Inferior Periareolar Incision, it does not present severe complications however aesthetic results are undesirable.

Mastopexia periareolar (circum-areolar) com implante mamário cônico: tratamento de ptose, hipomastia e alterações de posição e tamanho do complexo aréolo-papilar / Periareolar (circumareolar) mastopexy with conical breast implants: treatment of ptosis, hypomastia, and changes in position and size of the nipple-areola complex

INTRODUÇÃO: A cirurgia de mastopexia associada ao aumento mamário vem sendo cada vez mais solicitada. Ao mesmo tempo, pacientes com graus menores de ptose aceitam menos as correções por meio de cicatrizes verticais. Nesse contexto, a mastopexia periareolar (circum-areolar) com implante cônico é uma opção que resulta em cicatriz limitada ao perímetro areolar e possibilita o tratamento das alterações de posição e tamanho do complexo aréolo-papilar. MÉTODO: Foram avaliadas 22 pacientes, submetidas à mastopexia periareolar com utilização de próteses cônicas, revestidas com poliuretano, colocadas em posição subglandular e operadas pelo mesmo cirurgião. RESULTADOS: Dados observados: 45% das pacientes apresentavam ptose grau I; 32%, grau II, e 23%, grau III; 86% das pacientes apresentavam assimetria do complexo aréolo-papilar; 27%, lateralização, e 18%, aréolas grandes, havendo associações na mesma paciente. O volume das próteses variou de 215 mL a 380 ml. Houve dois casos de alargamento da cicatriz, mas não houve casos de alargamento de aréola ou cicatriz hipertrófica. Não houve, no período pesquisado, complicações relacionadas à colocação do implante. No questionário de satisfação, a maioria das pacientes considerou o aspecto da mama natural, conferindo boas notas aos aspectos: formato, simetria e altura das mamas, qualidade da cicatriz e posição, formato e tamanho das aréolas. CONCLUSÕES: A técnica permite resultados satisfatórios nos casos indicados, como ptoses leves a moderadas, aréolas grandes, lateralização e assimetria do complexo aréolo-papilar. São aspectos técnicos importantes: a retirada conservadora de pele periareolar, o uso de implantes de tamanhos moderados e a confecção da sutura de contenção em round-block.

INTRODUCTION: Mastopexy surgery associated with breast augmentation is increasingly being requested. At the same time, patients with lower degrees of ptosis are less receptive to any correction through vertical scars. In this context, periareolar (circumareolar) mastopexy with a conical implant is an option that results in a scar that is limited to the areolar perimeter, and enables the treatment of changes in the position and size of the nipple-areola complex. METHOD: We evaluated 22 patients submitted to periareolar mastopexy with use of conical prostheses coated with polyurethane and placed in a subglandular position. All patients were operated on by the same surgeon. RESULTS: Among the patients, 45% presented with grade I ptosis, 32% grade II, and 23% grade III, and 86% exhibited asymmetry of the nipple-areola complex, 27% lateralization, and 18% large areolas, with some combination in the same patient. The volume of the prostheses ranged from 215 to 380 mL. There were two cases of scar enlargement; however, there were no cases of enlargement of the areola or hypertrophic scar. During the period studied, there were no complications related to the placement of the implant. In the satisfaction questionnaire, most of the patients considered the aspect of the breast to be natural in appearance, giving good grades to the size, symmetry, and height of the breasts; the quality of the scar; and the position, shape, and size of the areolas. CONCLUSIONS: This technique produces satisfactory results in cases of mild to moderate ptoses, large areolas, lateralization, and asymmetry of the nipple-areola complex. Important technical aspects include the conservative removal of periareolar skin, use of implants of moderate sizes, and the use of the round-block containment suture.

Advances in the treatment of breast fibroadenoma surgery / 国际外科学杂志

Breast fibroadenoma is the most common benign tumor of female mammary gland,which is tend to occur in young women under the age of 30.The main treatment is surgical removal.The option of the method and timing of the surgery is effected by ages,fertility requirements,tumor size,location,and so on.Considering the young women of beauty and nursing requirements in the future,combined with medical cosmetology technology progress,the way to do surgery is particularly important.There are various surgical methods whose effects and applicable objects are different in clinic.In this article,the type of operation on breast fibroadenoma and timing of surgery were reviewed.

Removal of Breast Cancer and Immediate Breast Reconstruction by Periareolar Approach

PURPOSE: As the Korean life style is becoming westernized at a rapid pace, the rate of breast cancer is growing at the same time. So, the case of breast reconstruction after mastectomy increases, too. Points of breast reconstruction are symmetry, scar, size, and shape. Especially symmetry and scar are more important than others for Korean. This study is aimed to identify the method of breast reconstruction that accomplished the best results in terms of symmetry and scar. METHODS: A total 15 patients were operated on from March of 2005 to July of 2009. The 5 patients were reconstructed by mammoreduction method after periareolar incision, the 7 patients were reconstructed by pectoralis-major transfer with implant after periareolar incision, and 3 patient were reconstructed by both breast augmentation. RESULTS: Follow up period was 20.2 months on average and no complications such as breast deformity were observed. In symmetry of breast, the satisfaction score of periareolar approach is 4.4 and the satisfaction score of other approaches are 4.2(p>0.05). But in scar of breast, the satisfaction score of periareolar approach is 4.6 and the satisfaction score of other approaches is 3.4(p<0.05). CONCLUSION: In conclusion, Author's method of breast reconstruction after removal of breast cancer through periareolar incision is effective method in patients who care about aesthetic result after mastectomy.

Periareolar incision in treatment of gynecomastia / 中国基层医药

Objective To investigate the feasibility and safety of periareolar incision in treating gynecomastia, and whether it produces good cosmetic effects. Methods A total of 42 patients with gynecomastia treated by micro-incision of areola were retrospectnely anslyzed. Results The operation was successfully performed in all the 42 patients. Follow-up was done for 3 to 24 months, the surgical scars were obscure, and the sensation of nipple or areola were good. No operation-related complications were observed. Conclusion The periareolar incision in the treatment of gynecomastia was feasible and recommendable in terms of cosmetic maintenance and safety.

The Management of Capsular Contracture: Conversion to "Dual-Plane" Positioning through a Periareolar Approach

PURPOSE: The capsular contracture has been the most common complication of augmentation with breast implant, a side effect quite difficult to treat. The latest trends in the correction of capsular contracture include total capsulectomy or conversion of implant pocket. In this study, in an attempt to correct capsular contracture, the authors performed reoperation which involved capsulectomy through peri-areolar approach and dual- plane conversion. The authors hereby report the clinical results of such correction of capsular contracture and examine the efficacy. METHODS: The authors selected 46 patients who were admitted to the clinic from January 2004 to January 2007 (37 months), and performed dual-plane conversion through solely peri-areolar approach. Two types of operation were done: dual-plane conversion from subglandular plane or from submuscular plane. RESULTS: The average follow-up time after conversion to the dual-plane position was 10 months. During the follow-up period, 83.1% of patients recovered from capsular contracture and were Baker class I, and in 10.9% the condition had relapsed into Baker class II or III contracture. CONCLUSION: This study has proven the effectiveness of the dual-plane conversion operation for correcting established capsular contracture after previous augmentation mammaplasty. In this study, all cases of dual-plane conversion operation was performed through peri-areolar approach, which can prevent the occurrence of visible scar on inframammary fold.

Periareolar Dual Plane Augmentation Mammaplasty

Although several reports have been introduced about dual plane augmentation mammaplasty, the description of periareolar approach dual plane augmentation mammaplasty was few. This article describes specific characteristics, and different classification and techniques for the periareolar dual plane breast augmentation while postoperative scars resulted from inframammary crease approach caused complaints. A total of 124 patients(248 breasts) had periareolar dual plane augmentation surgery from 1998 to 2004. Anatomic implants were used in 43 cases. Most of the patients were satisfied with the outcomes of periareolar dual plane augmentation. Periareolar dual plane augmentation mammaplasty adjusts implant and tissue relationships to ensure adequate soft-tissue coverage while optimizing implant-breast parenchymal dynamics to offer increased benefits and fewer faults compared to a single pocket location in a wide range of breast types with minimal scars. Two types of dual plane classifications are discussed in this study for the periareolar approach exclusively. The boundaries of retroglandular dissection remain constant, as the costal origin of pectoralis major are divided. Type A dual plane implies that the inferior edge of pectoralis muscle lies below the inferior areolar border, and type B dual plane implies that the inferior edge lies above the superior areolar border.

Injeção periareolar do corante azul patente V e de tecnécio-99m-fitato por via peritumoral para a biópsia do linfonodo sentinela no tratamento do carcinoma invasor de mama

Após a aceitação da biópsia do linfonodo sentinela como importante método diagnóstico, busca-se definir detalhes para o aperfeiçoamento de sua técnica. Por exemplo, as injeções na parte central da mama procuram demonstrar que marcam o mesmo linfonodo sentinela que as realizadas na região peritumoral, a despeito do quadrante onde se encontra a lesão. Esse estudo foi realizado com o objetivo de comparar os resultados da injeção de Azul Patente V, periareolar, em quatro pontos, com a de 99mTc- fitato, peritumoral, subdérmico, em cada uma da pacientes com carcinoma ductal infiltrante, incluídas em sua casuística. Desse modo, através um estudo analítico e prospectivo, tipo relato de casos, se procurou verificar o índice de sucesso de cada método, bem como a sensibilidade e a especificidade da injeção periareolar, considerando-se como padrão ouro a técnica radioguiada. Foram avaliadas 53 pacientes do sexo feminino, na quais se diagnosticaram 54 carcinomas, sendo 51 do tipo ductal invasivo, dois do tipo lobular e um com esses dois tipos (ductal e invasivo), com dimensões entre quatro e 30 milímetros, diagnosticados por biópsias pré-cirúrgicas. A técnica periareolar obteve sucesso na marcação do linfonodo sentinela em 53 casos (98,15%), a peritumoral, radioguiada, em 50 (92,59%) e a combinação de ambas, método combinado, em 53 (98,15%). A sensibilidade da injeção periareolar foi de 100% e a especificidade igual a 25 %. Foram analisadas, também, algumas variáveis, como, a idade das pacientes, o quadrante onde o tumor se localizava, o tamanho da lesão, o tipo de carcinoma, o resultado da linfocintilografia, o grau histopatológico, a presença de metástases no linfonodo, entre as quais, somente esta última pareceu influir significativamente no êxito da marcação. Conclui-se que a injeção periareolar, em quatro pontos, de Azul Patente V pode marcar o mesmo linfonodo sentinela que a peritumoral de 99mTc- fitato a despeito do quadrante em que o tumor esteja localizado e da idade das pacientes, o que facilita o procedimento, pois é de mais fácil aprendizado e não necessitar de aparelhos dedicados necessários para a injeção do marcador em lesões impalpáveis. No entanto, deve-se ressaltar que não ocorreu marcação do LS fora da axila, por isso é conveniente que se façam novas pesquisas para se avaliar a importância de injeções profundas que, comprovadamente, o conseguem, principalmente, quando está localizado na cadeia da veia mamária interna

After the acceptance of the sentinel node biopsy as an important diagnostic method, the researches try to define details of the techniques for its optimization. For exemple, some researchers have arqued that a central injection (with a subareolar or periareolar techinique) may be beneficial. This study was realized with the aim of compare the results of the Patent Blue V periareolar in four points injection with the 99mTc- phytate perltumoral subdermal injection in all the invasive breast cancer patients studied. This way, through an analytical prospective study, case report type, we tried to verify the rate of successs of each method, as well as the sensibility and specificity of the periareolar injection, considering the radioguided technique as gold standard. Were evaluated 53 women in wich were diagnosed 54 carcinomas, 51 ductal invasive carcinomas, two lobular invasive carcinomas and one ductal and lobular invasive carcinoma; the tumor size was between four and 30 milimeters, diagnosed by preoperative biopsies. The periareolar technique was successfull for the detection of the SN in 53 cases (98.15%), the radioguided peritumoral technique in 50 cases (92.59%) and the combination of the two techniques in 53 cases (98.15%). The sensibility of peri areolar injection was 100% and the specificity was 25%. Some factors were examined for their correlation with the sucess of sentinel node localization rate using patient age, the tumour size, location, the histologic findings and the preoperative lymphoscintigraphic. Among all, only lymphoscintigraphy seemed associated with successful sentinel node localization. The conclusions were that periareolar Patent Blue V injection thechnique may detect the same sentinel node than peritumoral 99mTc-phytate injection in spite of the localization of the tumour and the age of the patients, what optimizes the procedure, because its easy for innexperienced surgeon to learn and does not require dedicated equipments to the injection in non-palpable lesions. Therefore, new studies are necessary to evaluate the importance of others injection techniques, like the ones realized in deep areas, that seem to possibilitate the detection of SN in different sites others than the axilla like, for exemple, mammary internal nodes

Identificação do linfonodo sentinela no câncer de mama com injeção do radiofármaco periareolar

O objetivo deste estudo é avaliar a injeção de 99mTecnécio-fitato periareolar em quatro pontos para identificaçao do linfonodo sentinela (LS) no câncer de mama. Foram estudadas 83 pacientes com diagnóstico de câncer de mama após receberem a injeçao do radiofármaco peritumoral ou periareolar em quatro pontos, para radiomarcação do LS, seguida de Iinfocintilografia e biópsia do LS. Os casos foram consecutivos, divididos em Grupo A - injeçao peritumoral em 12 pacientes e Grupo B - injeção periareolar em 14 pacientes. Foram realizadas nos grupos A e B, biópsia do linfonodo sentinela e Iinfadenectomia axilar. Estudamos ainda, um Grupo C - injeção periareolar e linfadenectomia axilar, se linfonodo sentlnela resultasse positivo em 57 pacientes. A Iinfocintilografia foi realizada em todas as pacientes. Nos casos em que não houve migração do radiofármaco, foi utilizado o azul patente. Realizamos em todos os linfonodos sentinelas exame por' imprint citológico corados pelo azul de toluidina e histopatológico corados pela hematoxilina e eosina. As taxas de identificação do LS foram de 66,6% (8/12) no grupo A, de 85,7% (12/14) no Grupo B e de 89,4% (51/ 57) no Grupo C. O número de LS variou de 1 a 3, média de 1,3, no grupo A, com 25% (3/12) de acometimento metastático. O grupo B apresentou variaçao de 1 a 4, média de 1,6 LS, com 21% (3/14) de metástases. O grupo C apresentou variaçao de 1 a 4 lInfonodos, média de 1,8, com 8,7% (5/57) de Iinfonodos comprometidos. Este estudo demonstra que a injeção periareolar de 99mTecnécio-fitato em quatro pontos apresentou taxas de identificação superiores a 85%. Embora controverso, a "possibilidade de padronizar o sítio de injeção, independente de procedimentos estereotáxicos, parece racional

The goal of this study is to evaluate the periareolar injection of 99mTechnetium-phytate in four points to identify sentinel node in breast cancer. A total of 83 patients diagnosed with breast cancer received peritumoral injection or periareolar in four points for radiolabel sentinel nodes, followed by lymphoscinitigraphy and sentinel node biopsy. The patients were consecutive, in two groups. Group A - peritumoral injection in 12 patients and Group B - periareolar injection in four points in 14 patients with sentinel node biopsy and axillary dissection. We also studied a third group, Group C - periareolar injection with axillary dissection when sentinel node biopsy was positive in 57 patients. Lymphoscintigraphy was performed in all patients. When the radiopharmaceutical didn't reach the axilla, isosulfan blue. was used. Histopathological studies were performed by cytological touch preps and hematoxyilin-eosin in all sentinel nodes. The identification rate of sentinel node was 66.6% (8/12) in Group A, in Group B were identified 85.7% (12/14) and in Group C were identified 89.4% (51/57). In Group A, the number of sentinel nodes has varied from 1 to 3, media of 1.3, with 25% (31/12) metastatic involvement. Group B has varied from 1 to 4, media of 1.6 sentinel nodes, with 21% (3/14) metastatic involvement. In the Group C it has varied of 1 to 4 sentinel nodes, media of 1.8, with 8.7% (5/57) metastatic involvement. This study demonstrates that periareolar injection of 99mTechnetium-phytate reaches identification rates above 85% and it is successful in identifying axillary sentinel nodes. Although controversial, the possibility in creating a standard protocol to identify sentinel node, without stereotaxis procedure seems to reasonable

Application of Periareolar Approach to Diverse Mammoplasty

Augmentation mammoplasty can be performed through various ways such as transaxillary, inframammary, periareolar and transumbilical approaches according to the patient's breast contour, body shape, and patient's and physician's preference. Each approach has unique pros and cons. From March, 2000 to October, 2002, we have applied periareolar approaches for augmentation mammoplasties in 69 patients, 134 breasts. Periareolar approach has several advantages. It is easy to access to the subpectoral space technically because of shorter distance and direct visualization. It requires smaller incision and leaves inconspicuous scar. Using endoscope, precise dissection of subpectoral space and hemostasis during operation could be achieved. We have kept fill-tube attached to the saline implant even after the surgery in selective cases. On the following day after the surgery, patients could check her breast contour, size, and symmetry by themselves in front of the mirror. Additional adjustment of implant volume was possible in the range of 10 to 15 per cent and it would decrease patient's complaint about the final result. We have introduced endoscope in periareolar augmentation mammoplasty in some cases. It allows us direct visualization of the subpectoral space and the origin of the pectoralis major muscle, and more accurate manipulation and hemostasis were possible. We have applied periareolar approach to various situations such as primary procedures in hypoplastic breasts, asymmetric breasts and secondary procedures in capsular contracture, rupture of mammary implant and combined operation with breast cancer or inverted nipple. Periareolar approach can be applied for diverse cases of mammoplasty, whether it is primary or secondary procedure, successfully because of its easiness, convenience, safety, economical efficacy and positive effect for doctor-patient relationship.

Reduction Mammoplasty using Modified Round Block Technique

The goals of reduction mammoplasty are to remove the appropriate amount of breast tissue and to make the nice cone-shaped breast. For these goals, various methods have been used and newly introduced. Recently, as women's interest in cosmetic attractiveness increases, surgeons make attempts to minimize postoperative scars. Periareolar approach has an advantage of invisible postoperative scar, but has many disadvantages - flattening of breast shape, recurrence of breast ptosis, hypertrophy and widening of periareolar scar, enlargement and distortion of areola caused by tension. After Benelli introduced Round block technique, this approach became one of the most popular methods. The characteristics of Round block technique are periareolar approach, superiorly based dermoglandular pedicle, criss-cross mastopexy, and Round block suture. Authors modified periareolar Round block technique to adjust to Korean women and have operated on 11 patients since 1997. We focused on medializing the lateral portion of inframammary fold and avoiding asymmetry and protrusion of nipple-areolar complex. Round block suture with uniform thickness and length must be applied at the same time to prevent areolar complications. In design, authors referred to the statistical analysis on Korean female. The results are aesthetically and functionally satisfactory and there has been no significant complication. In conclusion, this method is effective for young woman or mild macromastia with moderate ptosis. Besides, an accurate understanding of each step of operative procedure and enough knowledge of anatomy and physiology of the breast are essential.

Periareolar Reduction Mammoplasty

The goals of the reduction mammoplasty are to reduce the volume of the breast, to create aesthetic shape that is stable over time, to maintain blood supply and innervation to the nipple-areolar complex, and to make fine limited scars. There are 3 rationales in our reduction mammoplasty. To reduce the scar, we perform the periareolar incision. To make effective reduction of the breast volume, and to preserve blood supply and innervation to the nipple-areolar complex, we use a central or an inferior pedicle technique. To prevent areolar widening, we use a purse-string suture. We performed the periareolar reduction mammoplasty to 36 breasts in 18 patients from Jul. 1998 to Jun. 2000. The mean follow up period was 8 months. The mean age was 41 and mean resection amount was 420 gm per breast. Most patients satisfied with their fine periareolar scars, adequate size of breasts and the innervation of the nipple-areolar complex. We applied this procedure to all kinds of macrostomia. The greatest advantage of the periareolar reduction mammoplasty is the inconspicuous limited scar. Other advantages over conventional technique include preservation of sensitivity to the nipple-areolar complex and shorter operative time. As disadvantages, 10 breasts(28%) showed areolar widening. In 8 of 10 breasts with areolar widening, purse-string suture was not applied in the skin flap margin of the outer circle and reoperation was executed to reduce the areolar size by excision of the widened areola. The application of the purse-string suture was carried out in 6 breasts. Two breasts with purse-string suture showed areolar widening possibly due to loosening of the purse-string suture knot. There were persistent periareolar wrinkles in 4 breasts and poor sensitivity to the nipple-areolar complex in 6 breasts in which more than 500 gm of breast tissue per breast was resected. Periareolar reduction mammoplasty is optimal for patients who require reduction of lesser than 500 grams per breast. In the severe macromastia with or without ptosis, inverted T-incision is preferable to the periareolar incision, and periareolar incision can be modified by adding wedge resection of the outer excess skin flap inferiorly which results in a periareolar and vertical scar below the nipple-areolar complex.

Clinical Application of Reduction Mammaplasty with Various Methods

Breast has been considered as the symbol of the female. Ideal size of the breast was related to the age and culture. The goal of reduction mammaplasty is breast with natural cone shape, minimizing scars, well-placed and sensate nipple-areolar area and maintaining breast physiology. The ideal breast reduction should create beautiful breast with limited scars. We performed 37 cases of reduction mammaplasty. The techniques used were inferior dermal flap technique for 16 cases, vertical reduction mammaplasty for 18 cases, and periareolar round block technique for 3 cases. We compared advantages and disadvantages of the techniques and set up useful guide-lines to match the technique with the problem of each individual. The guidelines are as follow: 1. Inferior dermal pedicle technique is suitable for moderate to severe macromastia with ptosis. 2. Vertical reduction technique is effective for moderate macromastia in young women. 3. Periareolar round block technique is effective for mild to moderate macromastia in young women.