title: Alternative technique for breast augmentation in patients with a small nipple-areolar complex diameter.
abstract: BACKGROUND
  The use of the periareolar incision in breast augmentation procedures results in inconspicuous scarring. However, this approach is problematic when treating a patient with a small nipple-areolar complex (NAC) diameter.
  
  
  OBJECTIVE
  We describe a simple procedure for breast augmentation in patients with a small NAC diameter that uses an alternative periareolar approach to produce a scar similar to that resulting from the conventional periareolar incision.
  
  
  METHODS
  The conventional periareolar approach requires an areolar diameter of at least 3 cm for breast augmentation. We utilized geometric calculations to obtain values of perimeters and areas of hemi-ellipses for circles with diameters between 2 and 2.9 cm that are similar to the values calculated for a circle 3 cm in diameter. We applied the findings to our surgical technique. A crescent moon-shaped incision was made using a zigzag pattern on the hemiareolar inferior border, and the epidermis was removed from this area. The dissection was made through the mammary parenchyma and by way of the external arch. The inframammary crease was lowered enough so that the implant would be centered under the nipple when the incision was closed. A silicone gel-filled implant was inserted, and the lower edge of the incision was overlapped onto the deepithelialized upper flap, allowing the edges of the wound to join and seal in layers without requiring a purse-string support.
  
  
  RESULTS
  Between June 2002 and June 2004, we used this technique in 10 patients with areolar diameters ranging from 2.2 to 2.8 cm who requested primary breast augmentation with either cohesive gel or liquid silicone gel-filled implants. The resulting scar was satisfactory in color and quality for 8 patients; 2 patients had lateral widening of the scar. There was a slight change in the areolar diameter compared to the original diameter in all patients, but there were no deformities.
  
  
  CONCLUSIONS
  This simple procedure is an effective alternative technique for breast augmentation surgery in patients with a small NAC diameter.
authors.forename: Jenny
authors.initials: J
authors.lastname: Carvajal
authors.forename: Alberto
authors.initials: A
authors.lastname: Echeverry