By Dr. Hickman

Advanced Periareolar Purse String Breast Lift And Reduction: For Difficult Sagging (Ptotic) Breasts and Pendulous Heavy (Hypertrophic) Breasts.

Dr. Hickman
Women who seek cosmetic procedures for breast enhancement, lift, and reduction are particularly concerned about scarring as a result of a well intentioned beautiful operation on their breasts. Various approaches to breast augmentation leaving tiny scars are well known by the public.  The periareolar strategy refers to a special method where the nipple needs lifting beyond the capabilities of a breast augmentation alone where the surgeon adds additional lift to the breasts that leaves only a circular scar pattern around the areola.  Originally and still quite popular is the crescent lift which is used to raise  the nipple about 0.5 to 1 cm, and the donut lift which can raise the nipple 2 to 4 cm.  The advanced periareolar purse string breast lift and reduction can permit nipple elevations from 4 to 9 cm, practically eliminating the need for additional scars on the breast.  The procedure is not new but was developed and popularized by Benelli in France and Sampaio-Goes of Brazil. For patients who require 1 to 4 cm of nipple elevation, we have found the dual plane method of breast augmentation and some form of internal tailoring can eliminate the need for any lift scars.

While periareolar (circular scar) lifts with breast augmentation is featured by many Plastic Surgery practices, the amount of lifting ordinarily attempted with the periareolar approach may be limited to 4 cm of nipple elevation.  The extended use of this form of lifting has been a special interest of our Practice since 1992.  More patients can undergo breast lift in cases of increased difficulty and be candidates for no other than a circular skin closure around the areola.  It is not recommended for severe forms of breast sag or in patients with extremely large breasts.  Our precise technique follows the method of Brazilian surgeon Dr. Sampaio-Goes although he now incorporates an internal absorbable mesh material to wrap the lifted breast, feeling it adds even more structural support to the breast patients he has followed.  There remains controversy on this method when used in difficult cases.

Originally used by our Practice in some patients presenting with the occasional scar hardening from old silicone implants placed in the 1980s, where a revisionary implant change and lift was planned, we began using the method entirely for all such cases and in patients undergoing their first surgery for augmentation-lift.  Eventually the method in its pure form was applied to cases of increasing complexity for patients requesting minimal scar methods for sagging and heavy breasts.  Today we offer this method to all patients who require a lift with or without reduction, and for all patients undergoing augmentation with lifting.  It has replaced the T scar method in our Practice for all comparable breast problems. It still may be necessary to utilize a Vertical (lollipop scar) or Wise anchor type (T scar) pattern for the most severe sagging and heavy breasts.

Patient satisfaction has been excellent and long term stability of the method has been observed. At first the breasts may be slightly compressed and display small pleats around the circular scar but these features rapidly improve over weeks.  Some areolar stretching and slight starburst scarring may be seen particularly in women who have very loose elastic skin, stretch marks, and in whom large areolae were present before the operation. Complications particularly with reference to scarring around the areola and a need for revision have been extremely low.  The operation takes about 3 hours for a breast lift, 3 ½ hours for an augmentation and lift, and from 3 to 4 ½ hours for a breast reduction. This method is one of several minimal scar breast procedures that you can discuss with your plastic surgeon, who is certified by the American Board of Plastic Surgery.  Your Plastic Surgeon will advise the best approach for you.