Procedure
The fresh new semicircular approach (Fig. step three ) is basically an equivalent techniques because you to discussed from the Webster in the 1946 7 to have gynecomastia. A sufficient amount of glandular tissue should be remaining into the situ in NAC to get rid of a depression. The specific advantageous asset of this method ‘s the small and really-hidden scar that is confined in order to (the reduced 1 / 2 of) the newest breast-areola complex. The big drawback is the short windows whereby to the office, to make excision off nipple cells and hemostasis more difficult.
Inside instances of smaller tits having highest prominent nipples, the fresh transareolar techniques (Fig. 4 ) is utilized. This is certainly much like the process described because of the Pitanguy inside 1966 8 and makes it possible for subtotal resection and you will immediate reduction of the newest breast. This new ensuing scar traverses the new areola horizontally and you may passes inside the upper facet of the nipple.
The brand new concentric rounded strategy (Fig. 5 ) is a lot like you to definitely explained from the Davidson into the 1979. nine It is utilized for breasts having a moderate-size of surface envelope (B mug), or even in the truth regarding smaller breasts with poor facial skin flexibility. Brand new ensuing scar will be confined into circumference of areola. New concentric cut are going to be taken as the a group otherwise ellipse, permitting deepithelialization away from a calculated number of skin about vertical or lateral guidelines. cuatro , 5 Availableness try achieved through a cut regarding the substandard element of the outer community making a broad pedicle into the NAC. A purse-sequence suture is placed and put with the wanted areolar diameter (constantly 25–31 mm). The main benefit of this technique is that it permits getting protection and/otherwise repositioning of the areola, in which needed, and also for the elimination of an excessive amount of facial skin.
The fresh prolonged concentric round techniques (Fig. six ) is like the concentric rounded approach, however, comes with several a lot more triangular excisions out-of skin and subcutaneous structure horizontal and you will/ or medial. This process is useful for fixing body way too much and you may wrinkling lead from the highest differences between the inner and you will outer groups. The resulting scars will be within the areola, that have lateral extensions onto the breast skin, according to the level of a lot of skin.
The newest 100 % free nipple graft technique (Fig. 7 ) has been proposed by several article authors to own people having large and you can ptotic bust. dos , step three , 10 , 11 , twelve They includes harvesting this new NAC because a full-thickness epidermis graft; amputating brand new nipple; and grafting the fresh new NAC onto their the fresh venue towards the bust wall surface. The taste is always to put the cut horizontally 1 to 2 cm above the inframammary flex, right after which to go upwards laterally underneath the lateral border out of the newest pectoralis significant muscles. This new keeping the fresh NAC always represents the next otherwise fifth intercostal place. Health-related wisdom try foremost, not, therefore we always remain the in-patient upwards intraoperatively to evaluate last nipple condition. Some great benefits of the fresh new totally free nipple graft method are simple breasts contouring, sophisticated exposure and more quick resection out-of tissues, and additionally nipple avoidance, areola resizing, 
and repositioning. New drawbacks may be the enough time residual markings, NAC pigmentary and neurological transform, and probability of incomplete graft simply take.
Challenge
Postoperative issue include hematoma (popular, even after drains and you will compression bandages), (partial) breast necrosis, and you will abscess creation. Which underscores the importance of achieving good hemostasis intraoperatively. Quicker hematomas and you will seromas are exhausted thanks to puncture, but for large choices surgical evacuation will become necessary.
Other perhaps not infrequent complication includes skin slough of NAC, that is leftover in order to repair of the old-fashioned means. The new exceptional instances of limited otherwise total breast necrosis might require a holiday nipple repair. In new clients rather than complications,