LAUSR

We have read the article, ‘‘Sting technique: a new procedure for hypoplastic lower breast poles,’’ [1] with great interest. The authors are to be commended for their efforts and contribution to the global plastic surgery community. Development of novel techniques for treatment of complex surgical problems in general is incredibly important, and the addition of such techniques is paramount to the progression of our specialty as a surgical field. Breast augmentation in patients with breasts having a hypoplastic lower pole is a difficult and challenging condition, and an optimal outcome can be difficult to achieve. Often if the plastic surgeon performing the breast augmentation is not addressing this problem, augmenting a breast with a hypoplastic lower pole can result in a ‘‘double-bubble’’ deformity [2–4]. The article written by Campiglio and his colleagues presents initial data that aim to provide modern plastic surgeons with clever and innovative techniques to effectively augment and achieve an aesthetically pleasing result in patients with hypoplasia of the lower breast pole during primary breast augmentation. Typically, in patients with hypoplasia of the lower breast pole, the inframammary fold has a short distance to the areola while the inframammary fold is high as well [2]. The malposition of the inframammary fold is thought to be due to a developmental stenosis of the breast. The technique presented in this article percutaneously addresses the stenosis of the lower breast pole by performing a ‘‘needle aponeurotomy’’-like procedure with an 18-gauge angioplasty needle, while the breast is under tension from the placement of the implant. While taking care as to not puncture the implant, the superficial fascia is ‘‘released’’ using this sting technique to release the constriction of the lower breast pole. As the lower pole is released, the implant falls into an acceptable position. The authors have successfully prevented the ‘‘double-bubble’’ deformity with this technique. The technique presented by the authors propose a variation of the Rigottomy technique. The Rigottomy was initially described as a treatment for burn scars and other contracted scar tissue. The Rigottomy similarly used needles to puncture contracted or fibrotic scar tissue to create tunnels within the scar tissue that was subsequently used for fat grafting. The use of the Rigottomy was shown to be an effective means of softening hard and fibrotic scars. However, it is unclear whether this result was due to the regenerative properties of fat or the mechanical disruption of the scar tissue with the needle [5, 6]. Campiglio and his team applied this concept of mechanical disruption of the scar tissue to develop their ‘‘sting technique’’ and achieve impressive results. In their description of the ‘‘Sting Technique,’’ the authors followed 24 patients for an average of 17 months to provide an initial impression of the effectiveness of the technique. Patients who participated in the study were asked to rate their satisfaction on a scale of 0–10. The patient satisfaction data were complemented with an additional survey provided to a group of plastic surgeons. & Lee L. Q. Pu [email protected]