Techniques
Brand new semicircular method (Fig. step three ) is largely the same process just like the you to described by Webster when you look at the 1946 7 to possess gynecomastia. Enough glandular tissues might be left during the situ in NAC to end an anxiety. The specific advantage of this method ‘s the smaller than average really-undetectable mark that’s confined so you’re able to (the lower 1 / 2 of) the brand new breast-areola state-of-the-art. The top disadvantage is the quick windows whereby to your workplace, and work out excision out of nipple tissues and you can hemostasis harder.
Inside instances of reduced breasts having higher popular nipples, the brand new transareolar strategy (Fig. cuatro ) is used. This can be just like the procedure explained by the Pitanguy for the 1966 8 and you may allows for subtotal resection and instantaneous reduction of brand new nipple. The ensuing mark traverses new areola horizontally and entry within the top facet of the breast.
The newest concentric circular method (Fig. 5 ) is like one revealed by the Davidson during the 1979. nine It’s employed for tits with a medium-sized skin package (B cup), or in the truth out-of faster tits having bad body elasticity. The latest resulting mark might possibly be restricted with the width of your areola. This new concentric cut shall be removed since the a group otherwise ellipse, providing deepithelialization off a computed level of skin throughout the vertical otherwise lateral guidelines. cuatro , 5 Accessibility was gathered thru an incision on the inferior element of your own external circle leaving an extensive pedicle towards the NAC. A bag-sequence suture is put and put on the wanted areolar diameter (constantly 25–30 mm). The benefit of this procedure is the fact it permits to possess reduction and/or repositioning of one’s areola, in which expected, and for the removal of a lot of epidermis.
New expanded concentric circular techniques (Fig. six ) is like new concentric game strategy, however, boasts one or two most triangular excisions from epidermis and subcutaneous structure lateral and you can/ otherwise medial. This method is useful for fixing surface continuously and wrinkling introduced by the high differences when considering the interior and outer circles. The brand new ensuing markings might possibly be within the areola, which have lateral extensions onto the nipple skin, with regards to the degree of continuously surface.
The latest 100 % free breast graft approach (Fig. seven ) might have been recommended by a number of authors to have patients having highest and you may ptotic chest. 2 , step three , 10 , 11 , twelve It include harvesting this new NAC because the full-thickness skin graft; amputating the latest nipple; and grafting the new NAC on to its the fresh new place on the bust wall surface. All of our taste is always to place the cut horizontally one to two cm above the inframammary fold, following to go right up laterally underneath the lateral border from new pectoralis biggest strength. The newest keeping brand new NAC usually corresponds to the brand new fourth or fifth intercostal space. Medical view try foremost, not, and we also constantly remain the patient up intraoperatively to test final breast updates. Some great benefits of the totally free nipple graft techniques is actually effortless chest contouring, excellent publicity and a lot more quick resection regarding muscle, as well as nipple protection, areola resizing, and repositioning. The fresh drawbacks are the much time residual markings, NAC pigmentary and you can nerve changes, while the odds of unfinished graft capture.
Complications
Postoperative challenge include hematoma (most commonly known, despite drainage and you can compressing bandages), (partial) nipple necrosis, and abscess development. This underscores the importance of reaching an effective hemostasis intraoperatively. Shorter hematomas and you will seromas are going to be exhausted as a consequence of puncture, but also for big collections medical evacuation becomes necessary.
Other maybe not infrequent complication contains surface slough of one’s NAC, which will be left in order to restore of the conventional form. The exceptional cases of limited or En Д°yi Sosyal Medya TanД±Еџma Siteleri full nipple necrosis may need a secondary nipple reconstruction. Inside the new clients instead of challenge,