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Secondary Techniques in Breast Reconstruction Refinement: The Periareolar Advancement Flap

Oni, Georgette M.R.C.S.; Saint-Cyr, Michel M.D.; Maia, Munique M.D.; Colohan, Shannon M.D.; Rohrich, Rod J. M.D.

Plastic and Reconstructive Surgery: November 2011 - Volume 128 - Issue 5 - p 1015–1024
doi: 10.1097/PRS.0b013e31821e6d2c
Breast: Original Articles

Background: Techniques in breast reconstruction have vastly improved with natural feeling, aesthetically pleasing breasts created through transfer of free or pedicled tissue. Traditional flap designs incorporate a skin paddle that leaves a “patch,” which can be fairly large on the nouveau breast, clearly delineating the boundaries between the reconstruction and the native skin. In this article, the authors discuss the operative technique and present a clinical series of patients undergoing the periareolar advancement flap procedure. This technique reduces the skin paddle either to a circumferential areola-size area onto which the nipple can be simultaneously reconstructed (type I) or a single linear scar (type II) across the breast mound, thus enhancing the aesthetic appearance of the reconstructed breast.

Methods: A retrospective review of all patients between 2007 and 2009 undergoing periareolar advancement flaps under the care of the senior author (M.S.C.) was performed. Type of reconstruction, staging of procedures, additional operations, and complications were recorded.

Results: Fifteen patients had a type I procedure and six patients had a type II procedure. There were no major complications. One patient had minor nipple scabbing that resolved. All type I patients had concomitant nipple reconstructions at the time of their periareolar advancement flap.

Conclusions: The periareolar advancement flap is a useful technique to include in the range of secondary revision procedures for further refinement of autologous breast reconstruction. It results in a sensate, more aesthetically pleasing breast. It has low complication rates and can be performed at the same time as a nipple reconstruction in type I patients.


Dallas, Texas

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication December 27, 2010; accepted February 24, 2011.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Michel Saint-Cyr, M.D.; 1801 Inwood Drive, Dallas, Texas 75392,

©2011American Society of Plastic Surgeons