Application of Trans-Areola Approach for Costal Cartilage Harvest in Asian Rhinoplasty and Comparison with Traditional Approach on Donor-Site Morbidity

Overview

Harvesting rib cartilage through a chest wall incision leaves a visible scar, which is the main deterrent for Asian women considering rhinoplasty with their own rib. This study evaluated harvesting through an incision at the edge of the areola instead, and compared donor site outcomes with the conventional route.

Sections of note

• Patient records were reviewed to identify which harvest approach was used.
• Donor site outcome was evaluated 1 year after surgery using a visual analogue scale and the Modified Vancouver Scar Scale.
• Long-term complications in the trans-areola group were assessed at least 6 months after surgery.
• 26 females in the trans-areola group and 35 in the traditional group, of similar age and body mass index range.
• The trans-areola group had significantly longer surgery time.
• Pneumothorax rate 7.7 percent trans-areola versus 2.9 percent traditional.
• Trans-areola gave significantly better scar quality and higher overall satisfaction; its long-term complications were significant scars in 2 of 26 (7.7%), breast concavity in 1 (3.8%), and local chest pain or discomfort in 1 (3.8%).

What it means for a patient

• The areola route hides the scar but roughly doubled the rate of air leaking into the chest cavity, from 2.9 to 7.7 percent.
• One patient developed a dent in the breast where the cartilage was taken.
• Surgery took longer with the areola approach.
• Limits: 26 and 35 patients, retrospective, not randomized, one center, and only women.

Why this paper matters

Donor site scarring drives many patients toward synthetic implants instead of their own cartilage, so hiding the scar changes that calculation. The trade-off reported here is a higher pneumothorax rate. Whether that trade is acceptable depends on how the risk is presented and how reliably it is managed.

Terms

• Trans-areola approach: Harvesting through an incision at the edge of the nipple areola.
• Costal cartilage: Rib cartilage, used as a graft source.
• Donor-site morbidity: Problems caused at the place a graft was taken from.
• Pneumothorax: Air leaking into the space around the lung, causing partial collapse.
• Modified Vancouver Scar Scale: A validated scale rating scar appearance and quality.