Aesthetic Plastic Surgery | 2021
Letter-to-the-Editor: Percutaneous Intradermal Purse-String Closure for Correction of Male Tuberous Nipple-Areola Complex Deformity
Abstract
We have read with interest the case report of Carvajal et al. [1] about correction of tubular breast deformity in an adolescent male patient with a percutaneous intradermal purse-string suture resulting in minimal scarring. As well noted by the authors, acceptable scar positioning on the male anterior chest unfortunately is very limited and surgery to correct any male breast deformity is greatly challenging.The areolar area often exposed in sports and recreational activities being the main ‘‘aesthetic unit’’ on the male chest, skin incision and/or excision necessary to correct any male breast deformity should be limited to minimize visible scarring. The smallest possible frontal scars or, if possible, avoidance of noticeable scars is essential for patients who are concerned about their aesthetic appearance. The technique described by the authors is ingenious. With several stab incisions and a conventional lower hemiareolar approach, glandular tissue in excess is excised and the areolar diameter reduced by a modification of the Benelli technique using a 3-0 nylon purse-string percutaneous circumareolar intradermal suture. Surgical correction is completed with areolar skin excision limited to the redundant skin in the margin of the lower periareolar incision. This approach results in a limited inferior periareolar scar that is certainly less conspicuous than the unnatural look of the round scar secondary to periareolar excision with purse-string closure as usually recommended to reduce the size of the areola. Normally the boundary between non-pigmented and pigmented skin at the skin– areola junction is not sharply demarcated; moreover, the areola is rarely a perfect circle; it can hardly be restored with an artificial sharp line periareolar scar. Male tuberous breast deformity is rare, and described surgical techniques for its correction are few. However, its pathophysiology needs not be different than what has been documented in females. Regardless of the existence or not of constricting bands and despite different and seemingly contradictory theories, the main and primary anomaly in tuberous breast deformity that is a common denominator to all variants is an underlying abnormality in the quality of the skin of the areola with a deficiency of areolar dermal and fascial support. It is a congenital structural weakness of the nipple-areola complex (NAC) surrounded at its periphery by normal skin that may constitute a soft tissue ring through which breast tissue seems to herniate [2]. In male patients in whom gynecomastia may be entirely and solely retro-areolar, simple areolar widening and glandular & Fadl Chahine [email protected]