Breast Surgery with Application of Doughnut Mastopexy Lumpectomy Technique 95
subcutaneous fat and breast tissu e, in the approach to the
tumor. Even with all the aforementioned disadvantages,
periareolar incisions have the advantage of a better cos-
metic result after removal of fibroadenomas of 3 cm or
Since the length of a periareolar incision is limited, it
is not suitable for a large mass requiring excision. DML
has been reported to yield good cosmetic results after
tumor excision and excision of normal breast tissue, just
as it does in breast cancer surgery. In this study, tumors
and foreign materials were excised using the DML tech-
nique. If the mass was near the areo la, the doughnut inci-
sions were made in concentric circles. If the mass to be
excised was far from the areola, concentric circles would
stretch and deform the skin on the affected side; in such
cases, the doughnut area on the affected side was
enlarged, and the resected amount of skin was adjusted.
With the DML technique, the outer circumferential inci-
sion can be made much longer, facilitating tumor resec-
tion. The advantage of this method is that the incision
line can be changed according to the size and location of
the matter to be excised.
Unlike su rgery fo r benign tumor s, in su rgery for br east
cancer a large amount of normal breast tissue attached to
the tumor is excised in order to prevent recurrence. This
leaves excess skin behind. Even with benign tumors, the
skin can become stretched due to tumor enlargement;
similarly, the skin can become stretch ed if a foreign body
is present for a long duration. Because of this excess skin
retained after resection, a satisfactory cosmetic result
cannot be obtained by excision of a subcutaneous tumor
or foreign material alone. The DML technique solves that
problem with the adjustable nature of the doughnut skin
Breast reduction mammaplasty and mastopexy using
periareolar techniques are surgical methods based on the
same concept as the DML technique used in this study.
Typical surgical methods are the periareolar Benelli
mastopexy  and the Góes periareolar technique . In
the periareolar Benelli mastopexy, a dermal incision is
made along the doughnut’s outer circumference, where
the epidermis has been resected, from the 2 o’clock to the
10 o’clock position. The skin is dissected from this area
down to the inframammary fold. The central and caudal
breast tissues are usually the areas resected, then the sag-
ging breast is elevated cranially and fixed to the chest
wall. In the Góes periareolar technique, a dermal incision
is made around the entire outer circumference of the
doughnut, and subsequently the skin of the breast is dis-
sected and elevated from the breast tissue. The cranial
and caudal breast tissues are resected and the remnant
tissue is reshaped. The remnant doughnut-shaped dermis
in the periareolar region is dissected from the breast tis-
sue to create a dermal flap; this flap is then stretched over
the surrounding tissue to cover the breast mound as ex-
tensively as possible. The caudal aspect of the dermal
flap is fixed to the pectoralis major muscle and the cra-
nial aspect is fixed to the connective ligaments to en-
hance the effectiveness of the mastopexy. The aforemen-
tioned steps are the original method described by Góes
, however, the use of a dermal flap alone results in
laxity due to insufficient fixation of the breast mound.
Thus, Góes subsequently reported a modified method in
which mesh was used to cover the entire breast mound,
over the derma l flap, for fix ation . The method used in
our present report differs from the original method of
Góes in the following ways. In our series, the 2 cases of
breast reduction mammaplasty did not have sufficiently
severe breast enlargement or sagging to require a mesh or
dermal flap. In addition, it was unnecessary to dissect a
doughnut-shaped dermal flap from the breast tissue and
thus interrupt the blood flow to the nipple and areola.
In our study, doughnut mastopexy was performed in 4
breast surgeries that did not involve lumpectomy. Good
results were obtained in all 4 cases. Further studies will
be conducted in cases with different disease entities and
in greater numbers of cases to continue to examine the
usefulness of this method.
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