Reconstruction of Areolar Projection Using a Purse-String Suture Technique

Background: Nipple–areolar complex creation is the last step in the breast reconstruction process and plays a significant role in patients’ overall satisfaction. Although numerous surgical techniques have been described to create the nipple, very few procedures address the natural contour of the areola. Methods: We describe a surgical technique using a purse-string suture for improved areolar projection. After creation of nipple–areolar complex using a CV flap, evenly spaced stab incisions are made in a circular pattern, approximately 5 mm outside of the boundary of the proposed areola. Using these incisions, a nonabsorbable purse-string suture is placed in the deep dermis. The diameter is cinched down to the desired measurement, providing areolar projection. Results: Our experience using this technique has provided a satisfactory and stable projection of the areola in 10 patients with at least 1 year follow-up for each patient. There was no spitting of purse-string sutures in any of these patients, and there was no late areolar widening after at least 1 year follow-up. This provides a means for symmetry with an unreconstructed contralateral side. Conclusions: Improving aesthetic outcomes for areola reconstruction may further refine our goals of an ideal breast reconstruction.