Dr. Alejandro Nogueira's Case #VL9RBQHE

This patient had been previously operated elsewhere and unfortunately had been victim of the fraudulent periareolar lift, round block lift, donut lift, purse lift, Benelli lift or Goes lift among other given names; such technique is not a lift at all, the nipples never move towards any one direction, they stay the same location and never ever any lift is achieved.

It is easy understandable that cutting away skin around the areola does not apply any momentum or transposition effect on the areolas, they do not move; not only that, the breast reshaping cannot be accomplished, since just by pulling skin all over the breast towards the areola does not provide a breast gland restructuring which is a must do in all breast lifts; to the contrary, a deforming and grotesque effect of massive flattening is obtained, as it is obvious in this case.

Last but not least, the massive shortfall of skin around the areola creates a massive perimeter and circumferential tension and puckering, as an obvious consequence of stitching together one external ring which may be 3 or 4 times the length of the inner areolar edge ring; this massive tension creates the rippling or puckering lines irradiating from the areola, and sooner or later develops hypertrophic scars and scar widening; that is why among surgeons we know this pseudo technique leads to breasts like a fried egg this is flattened with massive central yolk areola and rippling around or Japan's flag-like.

It is absurd and reckless intending to suspend, sustain and reshape a whole ptotic or droopy breast which is out of shape just by means of a magical periareolar skin resection; needless to say this technique has been abandoned worldwide many decades ago by surgeons who practice in fields of realistic seriousness, honesty and results-oriented philosophy.

Once this periareolar skin resection is applied the sequels worsen over time, like in this patient's case which is bound to a full revision, only feasible by surgeons with solid experience in breast revisions of failed periareolar lifts.

In short, this patient's poor result is not due to poor planning or poor execution, hers is the typical, usual, regular and normal outcome of any well executed periareolar lift, since it is the typical result inherent to the procedure; unfortunately many women are victim of such procedure.

About the revision and repair of this mess it is not easy or accessible to any surgeon, needs deep understanding and knowledge, since it consists in converting the mess of periareolar missing skin into an inverted T or Wise pattern breast lift on a cut as you go intraoperative improvisation basis.

This means the surgeon can`t make many predictive preoperative markings and the final breast tailoring has to be made during the procedure on demand of the real skin shortfall and glandular reshaping requirements.

The fundamentals of the periareolar pattern conversion to an inverted T or Wise pattern is the recruitment of any spare skin and gland at the inner and outer parts of the breast and rotate it towards the areola so that the periareolar skin loss is restored and thus the areolar deformities corrected.

The animation deformity is due to the surgeon failing to release the pectoralis muscle from the skin when performing a partial submuscular or dual plane breast augmentation, leading to a dynamic deformity when contracting the muscle; this issue as very straightforward and simple treatment as well as prevention, which is separating the adhesions between the lower pole of the breast and the muscle.

Finally the patient received larger and wider implants, round shaped as per request.