The PAM method--periareolar augmentation mastopexy: a personal approach to treat hypoplastic breast with moderate ptosis.
BACKGROUND
Circumareolar incisions in breast augmentation surgery can center slightly low areolas on the breast mound and treat moderate ptosis. This maneuver, however, is limited to moderate cases because it does not achieve any lifting of the breast.


OBJECTIVE
The author describes periareolar augmentation mastopexy (PAM), a new systematic approach of breast augmentation and lifting through a circumareolar incision, by means of a vertical or T-plication on the lower pole of the breast.


METHODS
Twenty-eight patients underwent PAM. Intraoperatively, the epidermis was stripped on the area between the areola and the circumareolar incisions; after abundant tumescent infiltration, a detachment was performed on the areolar plane at the breast's lower pole. The submuscular plane was reached through a vertical incision on the breast, and a high-profile implant was placed. Over the same incision, a strong plication was performed to tighten the laxity causing the ptosis. The skin was closed with a purse-string suture.


RESULTS
The complication rate was low in this patient series: one case of small necrosis of the periareolar skin, one case of areolar asymmetry, three cases in which the areolas were not postoperatively round, and one case of infection in the unilateral purse-string suture. All patients saw great improvement in breast shape and were satisfied with ptosis correction. The technique results in minimal postoperative scarring, since it relies on a single circumareolar incision.


CONCLUSIONS
In this small series, PAM proved to be an excellent technique with consistent aesthetic results for correction of hypomastia in patients with moderate to minimally severe ptosis.
UNAERP Medical School at the University of Ribeirao Preto, São Paulo, Brazil. rg@raulgonzalez.com.br
Raul
R
Gonzalez
D000328:Adult; D001940:Breast / Q000473:pathology / Q000601:surgery*; D019928:Breast Implantation / Q000009:adverse effects; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult