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This article introduces a novel technique for refining the middle third of the nose in preservation rhinoplasty, adhering to the principles established by Teoman Dogan. The technique, applicable through both open and closed approaches, maintains the integrity of the nasal dorsum. The J-suture technique is particularly significant for addressing the widening of the middle third of the nose, a common issue in preservation rhinoplasty. This technique utilizes an absorbable percutaneous suture, allowing for the approximation of the upper lateral cartilages and thus thinning of the middle third of the nose. We discuss the technical aspects and advantages of the J-suture, emphasizing its simplicity, predictability, reproducibility, and ease of execution. The technique, requiring minimal training, can be adopted by any surgeon practicing preservation rhinoplasty. The J-suture represents a significant advancement in preservation rhinoplasty, providing a practical solution for enhancing nasal aesthetics while minimizing surgical trauma and promoting patient well-being.
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INTRODUCTION: The morphological result of nipple-areola complex (NAC) reconstruction may be disappointing for patients who undergo skin-sparing mastectomies and immediate breast reconstruction, followed by secondary reconstruction of the nipple-areola complex.The aim of this study was to analyze patient satisfaction after nipple-sparing mastectomy and immediate breast reconstruction with a deep inferior epigastric perforator flap. MATERIALS AND METHODS: Our retrospective study involved all patients who underwent an immediate breast reconstruction after unilateral mastectomy with conservation of the NAC. The following three kinds of surgical approach were used: mastectomy with periareolar incision, mastectomy with hemiperiareolar incision and lateral extension, and mastectomy with inverted-T mammoplasty incision. Our study was based on a survey using a standardized questionnaire and a Likert scale to report patient satisfaction on the basis of criteria defined by the investigators. RESULTS: We evaluated 17 patients. All reconstruction patients were satisfied or very satisfied with the overall aesthetic appearance, projection, and volume as well as the appearance of scarring on the reconstructed breast. None of our patients reported dissatisfaction in response to the criteria under evaluation. A periareolar incision was used most often to perform the mastectomy (10 patients). Partial NAC necrosis was observed in five patients, without negatively influencing their perception of the morphological outcome of their reconstruction. CONCLUSIONS: Immediate breast reconstruction using a deep inferior epigastric perforator free flap after nipple-sparing mastectomies met with a high rate of general satisfaction among patients and resulted in a low rate of nipple-areola complex necrosis.