Secondary techniques in breast reconstruction refinement:  the periareolar advancement flap.
BACKGROUND
Techniques in breast reconstruction have vastly improved with natural feeling, aesthetically pleasing breasts created through transfer of free or pedicled tissue. Traditional flap designs incorporate a skin paddle that leaves a "patch," which can be fairly large on the nouveau breast, clearly delineating the boundaries between the reconstruction and the native skin. In this article, the authors discuss the operative technique and present a clinical series of patients undergoing the periareolar advancement flap procedure. This technique reduces the skin paddle either to a circumferential areola-size area onto which the nipple can be simultaneously reconstructed (type I) or a single linear scar (type II) across the breast mound, thus enhancing the aesthetic appearance of the reconstructed breast.


METHODS
A retrospective review of all patients between 2007 and 2009 undergoing periareolar advancement flaps under the care of the senior author (M.S.C.) was performed. Type of reconstruction, staging of procedures, additional operations, and complications were recorded.


RESULTS
Fifteen patients had a type I procedure and six patients had a type II procedure. There were no major complications. One patient had minor nipple scabbing that resolved. All type I patients had concomitant nipple reconstructions at the time of their periareolar advancement flap.


CONCLUSIONS
The periareolar advancement flap is a useful technique to include in the range of secondary revision procedures for further refinement of autologous breast reconstruction. It results in a sensate, more aesthetically pleasing breast. It has low complication rates and can be performed at the same time as a nipple reconstruction in type I patients.


METHODS
Therapeutic, IV.
Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Georgette
G
Oni
Michel
M
Saint-Cyr
Munique
M
Maia
Shannon
S
Colohan
Rod J
RJ
Rohrich
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D013536:Suture Techniques; D015626:Tissue Expansion / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology