DOI: 10.1097/PRS.0b013e31824a9ea7

,  

,  

PMID: 22544133

Issn Print: 0032-1052

Publication Date: 2012/05/01


Print

The “Fish” Mastopexy

Melissa A. Doft; Krista L. Hardy; Jeffrey A. Ascherman

    loading  Checking for direct PDF access through Ovid

Excerpt

Traditional vertical mastopexy techniques do not explain how to lift a breast in a patient in whom the nipple is in the correct position and who has an aesthetically pleasing areola.1–3 Hidalgo introduced a Y-mastopexy technique for young patients with minimal nipple ptosis. Because of the grade I ptosis and a pleasing areolar diameter, a full circumareolar incision is unnecessary and instead a Y-extension to the vertical ellipse is made around the areola.4
For women desiring skin envelope tightening without nipple elevation, we suggest the fish mastopexy technique, in which a significant amount of skin horizontally is removed through a short vertical incision while nipple position is maintained. Three categories of women meet these criteria: the young Hidalgo patient, the patient who had a previous breast reduction and now seeks a mammaplasty for pseudoglandular ptosis, and the patient who underwent unilateral breast reconstruction who seeks a contralateral symmetrizing procedure for pseudoglandular ptosis. Unlike the traditional mastopexy patient, these patients have significant skin laxity coupled with a pleasing areola complex and a nipple that is not inferior to the inframammary fold.
Initial markings include the midline, inframammary fold, and breast meridian. The vertical skin incisions are drawn by displacing the breast from side to side. The edges of this ellipse will become the new breast meridian. Inferiorly, the vertical markings converge in the breast meridian 1 to 2 cm above the inframammary fold. They extend superiorly until 1 to 2 cm below the areolar margin, where a crescent is drawn. The inferior edge of the crescent is 1 to 2 cm below the areolar margin and the superior border is the areolar margin. The tips of the crescent are formed by connecting these two lines at the 9- and 3-o'clock positions of the areola. These markings create the outline of a fish (Fig. 1).
After deepithelialization, closure of the vertical limbs results in little or no distortion of the nipple-areola position. If a wide ellipse is removed, the dog-ears are cheated around the inferior areola border. Incisions are closed with 3-0 and 4-0 Polysorb (Covidien, Mansfield, Mass.)/Vicryl (Ethicon, Inc., Somerville, N.J.) sutures.
Over 4 years, the senior author (J.A.A.) performed the fish mastopexy in 15 of 59 mastopexy procedures (25 percent). Patients ranged in age from 34 to 71 years. Most patients sought symmetrizing procedures after breast reconstruction with an implant. No complications occurred. The technique reliably led to symmetrical breasts, with an unchanged nipple-areola complex location and minimal scar burden (Fig. 2).
The fish mastopexy should be considered when operating on a nipple-areola complex at or above the inframammary fold with ptosis of the glandular breast below the inframammary fold. The crescent incision around the lower half of the areola allows for the dog-ears of the vertical excision to be cheated around the nipple-areola complex; thus, a wider ellipse can be removed with a shorter vertical incision. By not incising the superior aspect of the areola, the normal pigmented transition is maintained without scarring, leading to a reduced perception of the scar pattern.
    loading  Loading Related Articles