Arié’s Technique: Surgical Principles and Its Historical Importance for Mastoplasty

Abstract

Vertical reduction mammaplasty through the Arié technique is indicated for mild to moderate breast hypertrophy and ptosis. Dissection of the skin is performed only at the periareolar area far enough to elevate the nipple–areola complex to its new position. An en bloc resection of skin and mammary parenchyma, including adipose and glandular tissues, with the shape of an orange seed, as pointed out by Arié in the original publication, is carried out from below the areola to the inframammary fold. The en bloc resection had the purpose of reducing the operation time, and providing a pleasant breast with minimal scarring. The medial and lateral pillars of the remaining breast tissue are approached together in the mid-line and anchored over the aponeurosis of the pectoralis with buried sutures from the second to the fifth intercostal space. Anchorage in the pectoral aponeurosis raises the breast, filling its upper pole resulting in a pleasant contour for the breast. Closure of the skin creates a vertical scar that crosses the inframammary fold, extending laterally and downward over the thoracic wall. A simple modification of the Arié vertical mammaplasty was proposed by Pitanguy in 1960 to reduce the length of the incision below the inframammary fold. It was named the Arié–Pitanguy technique. According to Pitanguy, the simplicity of Arié’s technique had the advantage of minimal tissue disturbance and avoided a scar in the inframammary fold where occasionally scar hypertrophy may occur. Reduction mammaplasty through a vertical incision proposed by Arié was a significant point in the development of reduction mammaplasty techniques. It was particularly important in the development of the breast plastic surgery in Brazil, but also influenced aesthetic breast surgery at an international level.