Areolar vertical approach (AVA) mammaplasty: Lejour's technique evolution.

The areolar-vertical approach (AVA) mammaplasty, derived from the Vertical Mammaplasty described by Lejour, offers us the opportunity to achieve good cosmetic results in breast reduction even in larger hypertrophies and makes it available to all patients. In marking, the skin there are certain fixed landmarks, but the final skin design is obtained by dynamic maneuvers (points A, V, and S). They do not follow a rigid pattern. This technique is based on the superior areolar pedicle and parenchymal resection, mostly from the central-lower pole. Shape and final contour rely on breast parechymal sutures and the gathering of excess skin mainly on the vertical portion of the scar. Complications are minimal; changes of sensitivity and function do not differ from those found with classic techniques. Finally, it seems that with this technique, the rate of complications is not related to the areolar-vertical approach, primarily because the vascular blood supply is equal to or more reliable than other superior pedicle techniques. Long-term results, symmetries, aesthetic scars, and patient satisfaction encourage me to continue with this procedure.