유륜둘레 절개법을 이용한 유방확대 수술 = Periareolar Approach for Augmentation Mammoplasty

다국어 초록 (Multilingual Abstract)

The periareolar approach provides central acess to all quadrants of the breast and is compatible with all the various breast implants and planes. This approach is also the choice when considering or planning a simultaneous mastopexy, and is also useful for dual plane dissection. Although the diameter of the areola is a limiting factor when contemplating this approach, areolas as small as 25mm in diameter will allow for creation of a 4-cm incision along one half of the areola circumference. The incision along the areola can also be lengthened by a zig-zag W incision. The damage of the breast parenchyme can be minimizes by making inferior subcutaneous dissection 3-4cm apart from the periareolar skin incision. The lateral edge of the pectoralis major can be identified and lifted easily after vertical cutting of breast parenchyma. The submammary or submucular pocket can be made accurately without difficulty by using blunt dissection or sharp electrocautery dissection. The bleeders are also cauterized easily with good visual field. The lateral branch of the 4th intercostal nerve can be identified and avoided from damage with direct vision. This approach is also effective in removing thick capsule after augmentation mammoplasty. The inferior portion of the pectoralis major is also cut along the inferior margin of the breast for dual plane dissection. The periareolar scar could be minimal by making W-shaped zig zag incision along a irregular skin areolar junction after making nonabsorbable mersilen intradermal suture to prevent scar widening.

참고문헌 (Reference)

1 Mladick RA, "”No-touch” submuscular saline breast augmentation technique" 17 : 283-, 1993

2 Tebbetts JB, "Transaxillary subpectoral augmentation mammaoplasty: a 9-year experience" 15 : 557-, 1988

3 Schlenz I, "The sensitivity of the nipple-areola complex: an anatomic study" 105 : 905-, 2000

4 Hwang K, "The lateral cutaneous branch of the fourth intercostal nerve relating to transaxillary augmentation mammoplasty" 53 : 27-, 2004

5 Deventer PV, "The blood supply to the nipple-areola complex of the human mammary gland" 28 : 393-, 2004

6 Lee EJ, "Submuscular augmentation mammaplasty using a perinipple incision" 52 : 297-, 2004

7 Graf RM, "Subfascial breast implant : a new procedure" 111 : 904-, 2003

8 Mofid MM, "Nipple- areola complex sensitivity after primary breast augmentation: a comparison of periareolar and inframammary incision approaches" 117 : 1694-, 2006

9 Würinger E, "Nerve and vessel supplying ligamentous suspension of the mammary gland" 101 : 1480-, 1998

10 Muntan CD, "Inframmary fold: a histologic reappraisal" 105 : 549-, 2000

11 Nanigian BR, "Inframmary crease: Positional relationship to the pectoralis major muscle origin" 27 : 509-, 2007

12 Tebbetts JB, "Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types" 118 : 81-, 2006

13 Hidalgo DA, "Breast augmentation: choosing the optimal incision, implant and pocket plane" 105 : 2202-, 2000

14 Spear SL, "Breast augmentation" 114 : 73-, 2004

15 Sarhadi NS, "An anatomical study of the nerve supply of the breast, including the nipple and areola" 49 : 156-, 1996

16 Carvajal J, "Alternative technique for breast augmentation in patients with a small nipple-areolar complex diameter" 25 : 117-, 2005

17 Tebbetts JB, "Achieving a predictalble 24-hour return to normal activities after breast augmentation: part II. Patient preparation, refimed surgical techniques, and instrumentation" 109 : 293-, 2002

18 Gryskiewicz JM, ""Zigzag" wavy-line periareolar incision" 110 : 1778-, 2002