Aesthetic Plastic Surgery | 2021
Invited Response on: “Management of Nipple-Areola Deformity”
Abstract
We would like to thank Dr Atiyeh and his colleagues for taking the time to read our article ‘‘Management of NippleAreola deformity’’ [1] and we are grateful for the opportunity to reply to the points raised in their letter [2]. We agree with Dr Atiyeh on the importance to diagnose the nipple areola complex (NAC) deformity prior to breast augmentation in order to avoid unsatisfactory results. Although Dr Atiyeh et al. focused only on herniated nipples in their letter, we presented different types of nonherniated protuberant nipples as well as their possible treatments. That was the starting point of our study and the reason why we proposed the algorithm. Our algorithm is designed to be a simple tool to plastic surgeons and to help them to choose an effective treatment of protuberant NAC in a sequence of steps after examining their patients. Furthermore, we presented some common surgical techniques for treatment of protuberant NAC but also our experience with a new, less invasive surgical technique. We indeed consider that the only successful way to correct tuberous breasts is to deal with the constricting ring. Our opinion is in accordance with other authors and pathoanatomic findings of the deformity [3–5], but Dr Atiyeh has a different point of view yet to be proven [2]. We understand that the diameter of the NAC is very important parameter, but the precise measurements of the NAC were beyond the scope of this paper. However, as we mentioned in the results, we did not have patients who complained of post-treatment wideness of the NAC. Perinipple round-block technique for correction of tubular breast deformity published by Atiyeh et al. [6], although quite limited, could be incorporated in therapeutical armamentarium in selected cases. The scar is located in the center of the areola, preserving the natural appearance of the skin-areola junction, which is, without any doubt, the advantage of this technique. But, in some cases, the perinipple scar may lead to pigmentation changes and flattering of the nipple [7]. Another formal contraindication is breasts augmentation cases with larger implants because of very tight skin envelope [7]. Our patients who were submitted to this technique also reported tactile and sexual arousal reduction. Because of possible complications, this procedure has not been well accepted by our patients. We appreciate the interest in our recently published technique for percutaneous correction of protuberant nipple [8]. The therapeutic indications for this technique, however, are clearly indicated in the article [1]. Percutaneous electrocoagulation of the NAC can be also viewed as a preventive method for NAC herniation and areola widening, because of the controlled scaring in the subdermal structures of the NAC [8]. We have been performing this technique successfully for last five years in selected cases. With regard to all the aforementioned, the statement of Atiyeh et al. about this technique in our opinion is baseless and purely speculative. & Katarina Andjelkov [email protected]