Double Skin Technique with Polyglactine or Mixed Mesh in Mastopexy and Breast Reduction

Introduction: The periareolar approach to breast reduction results in a circumareolar scar without vertical and horizontal components. The problems of this technique are widening of the periareolar scar, difficulty in obtaining proper breast shape, and early appearance of breast ptosis. The double skin technique using polyglactine or mixed mesh through a periareolar approach was utilized to see if the problems of the periareolar approach could be reduced. Materials and Methods: Since 1994, 100 patients have had a periareolar approach utilizing the double skin technique with polyglactine or mixed mesh. Age range was 19 to 49 years. There were 44 cases of mastopexy (breast lift) and 66 cases of breast reduction. The double skin technique is a periareolar pexy that utilizes a central large dermo-glandular pedicle, which is lifted (and eventually reduced) up to the desired new position and fixed at the costal margin. A second layer, represented by a large dermal flap, is utilized for the internal lining. A 910 polyglactine mixed mesh harvests the new breast cone to reinforce the new shaped breast. A round-block continuous nonabsorbable suture contributes to pull and distributes the tension of the internal cutaneous lining, while the areolar skin is sutured with a long-term absorbable continuous suture, in a double layer, leaving two independent elements sutured without tension. Conclusions: The experience of the author with the Goes technique includes a large series of patients with mild to medium ptosis and mild to medium hypertrophies. Having performed breast pexy and reductions with other periareolar techniques, experience shows that the present choice exactly fulfills all the requirements of the operation. Shape, projection of the breast, quality of the areolar scar, and long-term results are all improved in comparison with the techniques utilized in the past.