Technical Points to Circumareolar Breast Surgery: Markings and Skin Flaps

Abstract

As is emphasized repeatedly throughout this book, markings on the skin are not as important as the creation of the subcutaneous breast shape. Nevertheless, if an excess of skin is left in place, we cannot expect sufficient shrinkage to the new subcutaneous cone. On the other hand, the larger the circle of skin that is removed or deepi-thelialized, the more likely there is to be long- term wrinkling in the closure, and the greater the possibility that the surgeon will choose a “lollipop” vertical midline excision. In this book we assume that patient selection precludes the lollipop excision, and will demonstrate to you the technical maneuvers that virtually eliminate areolar spread and reduce the length of time in which the circumferential rippling is visible. In my technique, undermining is limited to the lower half or two thirds of the breast. Other authors have no hesitation in undermining all of the breast skin, which diminishes blood supply.