A new implant methodology for the patient with a small nipple-areolar complex diameter.

[BACKGROUND] Both the conventional periareolar approach and the inframammary approach present difficulties in breast augmentation when treating the patient with a small nipple-areolar complex diameter.

[OBJECTIVE] We describe an approach that uses a 360-degree periareolar incision.

[METHODS] A ring of skin was demarcated around the areola by outlining 2 concentric circles. The epidermis between the rings was removed. The deep dermis was cut in a ring, with the 3- and 9-o'clock positions of the outer circle being the start and finish of the approach, until the subglandular or submuscular plane on the outside of the inferior external edge of the pectoralis muscle was reached, thus developing the pocket. After implant placement, primary closure was accomplished by using 3-0 nylon purse-string sutures and 5-0 nylon dermal interrupted sutures.

[RESULTS] The procedure was successful in a series of 23 patients treated between January 1992 and July 2000.

[CONCLUSIONS] This approach provides an adequate surgical field with an excellent view of the surgical pocket and easy management of hemostasis, and it permits placement of the implant without damage to the device or the skin margins. (Aesthetic Surg J 2001;21:320-327.).