title: Periareolar Access for Pectus Excavatum Correction with Silicone Implants: A New Method to Minimize Postoperative Scars-Review of the Literature, Considerations and Statistical Analysis of Clinical Outcomes.
abstract: BACKGROUND
  Pectus excavatum (PE) is one of the most frequent thoracic malformations. Generally, the malformation is not associated with functional disorders and often constitutes an aesthetic alteration with significant psychological distress.
  
  
  OBJECTIVE
  To reduce the visibility of the residual scarring produced by corrective surgery and to improve the aesthetic outcome, the authors propose a new prosthetic implant technique through a periareolar access.
  
  
  METHODS
  From January 2005 to January 2015, 11 patients affected with PE underwent the surgical procedure with a sternal prosthesis implanted through a periareolar access with the help of a fiberscope. The preoperative evaluation of the perception of the malformation and postoperation results were made using different questionnaires. The data collected in our series were compared with that reported in 4 different papers where other forms of access were used: sternal, inframammary and transumbilical.
  
  
  RESULTS
  No major complications or dislocation of the implants were reported. Among the complications, 6 postoperative seromas were reported. The patients' perception of improvement through the use of 2 questionnaires and an evaluation scale showed substantial improvement in all the aesthetic outcomes.
  
  
  CONCLUSIONS
  The periareolar technique provides excellent cosmetic results compared to the sternal one. This access causes fewer complications and necessitates a shorter average hospital stay than the sternum access. To conclude, according to what is shown in the literature, periareolar access seems to be a quicker procedure, requiring a shorter stay in hospital, and results in scars that can more easily be hidden and are more accepted by patients.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Plastic and Reconstructive Microsurgery, Careggi Universital Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy. innocentialessandro@alice.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Innocenti
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Bari, Foggia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ciancio
authors.affiliation: Plastic and Reconstructive Microsurgery, Careggi Universital Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Melita
authors.affiliation: Plastic and Reconstructive Microsurgery, Careggi Universital Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.
authors.forename: Mori
authors.initials: M
authors.lastname: Francesco
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Bari, Foggia, Italy.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Portincasa
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Bari, Foggia, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Parisi
authors.affiliation: Department Statistica, Informatica, Applicazioni "G.Parenti" DiSIA, University of Florence, Florence, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Dreassi
authors.affiliation: Plastic and Reconstructive Microsurgery, Careggi Universital Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Innocenti
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D009558:Nipples; D011379:Prognosis; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020034:Silicone Gels; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020034:Silicone Gels
keywords: Pectus excavatum; Pectus excavatum correction; Pectus malformation; Silicone implant