Crescent Mastopexy With Augmentation and Hemi-Interlocking Circumareolar Mersilene Suture: An Innovative Approach

Abstract

Introduction: Safety and patient satisfaction of crescent mastopexy and concurrent primary or revisional augmentation mammoplasty is controversial owing to secondary asymmetry and potential complications involving breast tissue and the nipple-areolar complex (NAC). The primary objective of this case series was to present a new technique that can achieve anatomic integrity and natural morphology of the NAC, while avoiding complications and minimizing scarring and hypertrophic alterations. Materials and Methods: Using white nonabsorbable 3-0 polyester mersilene suture for tension-free closure, the procedure was completed via intradermal insertion of the needleless end of the suture into the circumareolar NAC-skin junction at the inferior segment and an interlocking purse-string or spoke-wheel configuration in the superior segment, juxtaposing the NAC and cutaneous margin, thereby redistributing the tension line from the crescent scar to a circumareolar, cranially repositioned site. Patients were followed at 24 hours, 1, 3, 6, and 12 weeks, and 6 and 12 months. Postoperative pain was patient-measured using the Visual Analog Scale (possible scores ranged from 0 to 10), and esthetic satisfaction was determined by patient surveys (scores 0-5). Follow-up visits involved evaluation of scars, nipple sensation, nipple-areolar perfusion by capillary refill, asymmetry, and hypertrophic and pigmentation changes. Results: Six patients (ages 32-46) underwent 2 primary procedures and 4 revisions between January 2020 and March 2023 and were chosen retrospectively based on inclusion and exclusion criteria. One revision was completed using the traditional method while the rest were completed with the new technique. Surgical times ranged from 15:34 to 17:35 minutes, with patients reporting minimal initial and postoperative pain, high patient satisfaction, and reduced scar visibility. All patients reported postoperative pain assessments as negligible initial pain on days 0 to 3 (0) and 1 to 2 on days 4 to 7, with 1 patient scoring pain as 2 to 3. Scar visibility was minimal (<0.5 mm), although 1 patient experienced 1.5 mm at 12 months. Shape of the NAC was maintained in all cases at 6 months, with 1 patient evolving to oval shape at 12 months. Patient satisfaction was scored at 4 and 5 at 6 and 12 months. No complications, scarring, or alterations in NAC shape or position were noted. Conclusion: This technique avoided resection of the mammary gland, achieved minimal tension and thereby preserved the crescent scar, corrected preoperative asymmetry and mild ptosis, proved superior aesthetic enhancement, and reduced complications compared with traditional methods. These promising results warrant further evaluation in a larger cohort.