Since its introduction, periareolar mastopexy has been used as a minimally invasive approach that limits the scars by placing them around the areola. This approach has been incorporated into augmentation mastopexy techniques that involve placement of a submammary or submuscular implant with reduction of the skin envelope. The advantages of the periareolar mastopexy are that it limits scars by mimicking the natural irregularity between the areola and the periareolar skin. The disadvantages are that it may lead to: 1.A flattened breast shape, 2. Stretching of the areolar complex, 3. Paradoxical pseudo-ptosis of the nipple-areola complex, 4. Hypertrophic scarring of the incision caused by tension and 5. Wound dehiscence.

The Doctor's Company has reported that periarolar augmentation mastopexy is the number one cause of dissatisfaction and lawsuits among patients undergoing cosmetic breast surgery. We present a series of 10 patients (Age range: 21-41; Average follow-up: 16 months) treated between 2002 and 2005 who had various complications attributed to periareolar augmentation mastopexy requiring further correctional surgery. Patients subjective complaints as well as objective findings were recorded and followed. All patients refused to undergo the traditional anchor scar operation and were all treated by the vertical mammoplasty technique to remove the scars, decrease the nipple diameter, reset the nipple position, and correct ptosis. The implant pocket, size and shape were also altered as needed in order to obtain the best shape possible. When presented with paucity of breast tissue, de-epithelization of the lower pole or use of alloderm provided sling support of the implant.

We present an algorithm to stratify these patients and provide our experience with the use of vertical mammoplasty technique combined with the appropriate pocket and type of implant to address these challenging problems.