11 Infra-areolar Zigzag Augmentation Mammaplasty

10.1055/b-0039-166521

11 Infra-areolar Zigzag Augmentation Mammaplasty

Ruth Graf, Priscilla Balbinot, and Daniele Tanuri Pace

Summary

Infra-areolar zigzag augmentation mammaplasty is a good approach in the breast to perform a breast augmentation. This technique provides a hidden scar inside the nipple-areola complex and good access to the gland. Breast tumors can easily be accessed and the pocket is easier reach. The zigzag incision placed the scar in the areola irregularities and camouflages the final aspect. The breast tissue is preserved and this access allows use of different shapes and sizes of implants.

Key Points

Augmentation mammaplasty is one of the most common surgeries worldwide.
Variables such as implant size and location as well as incision type influence the final result.
The periareolar approach is well known and disseminated, but the resulting scar is a common reason for patient dissatisfaction.
A modified periareolar technique using a zigzag incision that results in invisible scars after augmentation mammaplasty is an excellent alternative for augmentation mammaplasty and has an aesthetic satisfactory result with imperceptible scars in the periareolar skin of the nipple–areola complex, which is naturally irregular.

11.1 Introduction

Augmentation mammaplasties are most commonly done in the inframammary fold, areola, or axilla. It is important to decide with the patient where scars will be placed and the decision should be based on patient’s anatomy, implant size and shape, patient’s preference, and surgeon’s comfort level. ¹

Since periareolar and infra-areolar techniques were developed for breast augmentation, ² ^, ³ ^, ⁴ some discussions about best approach for implant placement emerged. ⁵ ^, ⁶ ^, ⁷ All incisions have advantages and disadvantages.

Objectives of periareolar (infra-areolar) breast augmentation surgery are as follows:

Less invasive surgery.
Direct access to breast implant pocket.
Minor scars/limited skin excision.
Broken line incision (camouflage).
Preserve the integrity and the entire soft-tissue thickness of the breast’s lower pole.
Safe implant coverage.
Incision distention/length increase to favor implant placement.
Easy access to breast nodes/lumps.
Patient education and counseling of a less visible scar and minimal nipple sensation changes.

A modified periareolar technique using a zigzag incision that results in invisible scars after augmentation mammoplasty is an excellent alternative for augmentation mammoplasty and has an aesthetic satisfactory result with imperceptible scars in the periareolar skin of the nipple–areola complex (NAC), which is naturally irregular. ⁸ ^, ⁹ ^, ¹⁰

11.2 Technique

Skin markings are done with the patient in stand-up position. Precise measurements must be taken using the inframammary fold (IMF), the NAC, the suprasternal notch, and the breast base width as key landmarks.

The midline of the chest and IMF are marked. Lines are drawn first straight down the midline from the suprasternal notch to the xyphoid process and second the IMF 4 to 5 cm from the inferior border of the areola. Footprint of glandular tissue is drawn as a guide to implant pocket undermining and a 1 to 1.5 cm distance from chest midline is respected, to avoid symmastia.

Incision markings are performed in inferior half of NAC inside the areola skin, in zigzag shape, avoiding surrounding skin. The length of zigzag must be short to provide a hidden scar (0.5 cm each peaks and valleys). End parts of incision are at 3 and 9 o’clock in areola directing to nipple to avoid intraoperative damage to the skin (Fig. 11‑1).