The Round Block Breast LIft.

Scottsdale – One of the main goals of cosmetic surgery is to limit the scar. What does it mean anyway, Round Block?

Well, if one separates down the two words to their basic meanings, we get a reasonable understanding of what the operation is all about. For instance, the word round: Indeed, it is the desired shape of the areola. As the Round Block Breast LIft Diagram demonstrates, the operation involves the use of a larger circle closed as a purse-stringed into a smaller circle. The large circle represents the diameter of the areola before breast surgery. This is usually a large and unattractively wide diameter. The smaller circle is the new, smaller diameter which is achieved by the operation.

In the original description of the technique, the suture was placed within the dermis. The dermis is an important part of the anatomy in most plastic surgery operations of the breasts. In fact, most modern breast lift operations incorporated dermo-dermal sutures of some kind.

Details about Breast Lift and Breast Implants with Areola Technique.

The way the suture is placed is by going around the larger circle without incorporating the smaller inner circle. As we will see in the Tuesday’s blog, more modern variations of the round block breast lift now use both the inner and outer circles when placing the permanent suture implant to control the size of the areola. The rational for this variation has to do with the movement of the tissue around the suture. Most often, when more tissue moves around one side when compared to the other, then pleating of the skin can occur, which is more noticeable on the fast movement side of the areola. By incorporating both the inner and out circles more control occurs and less pleating results.

The Round Block Breast Lift: What Actually Happens?

Tightening the Suture: The Purse -String.

During the actual procedure, with or without breast implants, the suture is pulled by the surgeon to bring the edges of the wounds together (See Diagram: The Purse-String).  Once the desired diameter of the areola is set then the permanent suture is tied. It is important to set the diameter of the areola to a reasonable level. Too tight and it looks unnaturally small or there will be too much pleating.

To some degree, the areola will stretch after the breast surgery. This is specially true if breast implants have been placed during breast augmentation and areola reduction surgery. You see, all breast implants cause the skin to stretch. This may occur slowly or rapidly, depending on the size of the breast implant and the elasticity of the skin.

We don’t want the areola size to stretch. That is where the second word comes into play: Block. It is the block that occurs through the use of the permanent suture implant and the dermo-dermis closure that resists the forces of stretch and gives us a more predictable areola size. The round suture and the blocking wall of dermis scar that is created can even resist the pressure of stretch that is generated by saline breast implants.

After placing a permanent suture implant, what else has to be done? The board certified plastic surgeon, must close the more superficial layers of the skin and minimize pleating. How is this performed?

Best Closure for Breast Lift.

Best Closure for Breast Lift Around the Areola.

The best method I have found is to use a thin absorbable suture (it goes away – over time). Importantly, the needle on this suture should be blunt. It makes sense to use a blunt needle, although it is harder to work with for most plastic surgeons, because it will not slice the permanent suture holding the deeper tissues intact (See Diagram: Best Closure for Breast Lift). The cosmetic surgeon has to make minor adjustments of the skin to reduce pleating. In some cases, this is as simple as sliding the tissue to the other side or trimming any excess tissue without slicing the permanent suture below, of course.

There are pros and cons to all plastic surgery operations. In the last portion of this series, we will discuss more about how modern improvements in the technique make it more predictable and reliable. Please note that all the sketches and diagrams for this blog were created by Dr. Aldo Guerra, a board certified plastic surgeon, using Sketchbook Pro Program.