Abstract: One-Stage Augmentation Mastopexy: A Retrospective Ten-Year Review of 1,131 Consecutive Cases

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INTRODUCTION: Although numerous studies supporting simultaneous breast augmentation with mastopexy have been reported, concerns persist among surgeons regarding the safety of this procedure. With increasing frequency, patients are requesting that breast volume and skin tightness be enhanced in a single operative procedure to achieve a desired aesthetic outcome. The purpose of this study was to evaluate the safety and effectiveness of one-stage augmentation mastopexy procedures in primary and secondary cases by analyzing long term complication and reoperation rates. METHODS: A retrospective analysis of one-thousand, one-hundred and thirty-one consecutive one-stage augmentation mastopexy procedures performed by a single surgeon from January 2006 to August 2016. Patient demographics, operative technique and implant specifications were measured and correlated with surgical outcomes. Complication and reoperation rates were calculated and compared with published reports in the literature. RESULTS: Of the 1,131 one-stage augmentation mastopexy procedures analyzed, 725 (64%) were primary and 406 (36%) were secondary in which the patient had one or more previous breast augmentation procedures. Silicone gel implants were utilized in 471 (65%) of the primary and 324 (80%) of the secondary procedures. Operative technique involved a circumvertical or inverted-T mastopexy in 77% (n= 871) and a bilateral mastopexy in 93% of patients. The overall reoperation rate was 14.9% (13.2% of primary and 16.6% of secondary procedures) over a mean follow-up period of 43 months (range 4 months to 121 months). Tissue related complications consisting of recurrent or persistent ptosis and poor scaring were most common at 6.2% (n= 71). Implant related complications requiring a revision were most commonly a result of the patient’s desire to change implant size 3.1% (n=36) and capsular contracture Baker III/IV in 2.8% (n= 32). There were no cases of periprosthetic infection requiring explantation and no significant skin flap necrosis (> 2cm) or nipple areolar loss noted. CONCLUSION: One-stage augmentation mastopexy can be safely performed with a reoperation rate that is significantly lower than when the procedure is staged. The effectiveness of this procedure is defined by a low complication rate, acceptable aesthetic results, and by minimizing the number of operations for the patient. With appropriate patient selection and operative technique, acceptable outcomes can be achieved safely and effectively.