Three major categories of surgical approaches for mastopexy have been described: periareolar, vertical, and Wise pattern. 00 A paradigm shift in mastopexy took place when Benelli demonstrated that skin only mastopexies were not as durable as mastopexies that address the skin and parenchyma by redistributing the parenchyma. 00 Plastic surgeons now understand that by addressing both the outer lamella (skin) and inner lamella (parenchyma), more durable and predictable changes can be achieved in the ptotic, involuted breast.
Periareolar mastopexies can be used in patients who have grade I or II ptosis, nipple asymmetry, or widened areola (Figure 00.0). This technique can be used to elevate the nipple no more than 0 cm with an eccentrically designed oval. A variation of the periareolar mastopexy is the crescentic mastopexy in which a crescent is designed only superior to the existing areola. The periareolar mastopexy hides the scar along the areolar-breast junction. Removing skin in a concentric pattern can, however, flatten and reduce breast projection. Scar widening and eventual widening of the areola can occur, but some have advocated the use of a barbed or permanent suture to control this. If there is circumferential full thickness violation of the dermis, decreased nipple sensitivity may occur.