Reverse Mastopexy: A Novel Contouring Technique in Previously Reconstructed Breasts

Abstract

Reverse mastopexy is a novel secondary surgical technique applied to patients who have previously undergone skin-sparing mastectomies with reconstruction. Benefits of this procedure include a natural contour to the reconstructed breast with greater breast mound projection, enhanced superior medial fullness, and reduced contour irregularities. Aesthetic improvement to the breast is appreciated with scar relocation to the inframammary fold. Nipple areolar reconstruction can then be performed in surgically undisturbed tissue. Eleven patients from January 2015 through January 2016 who underwent reverse mastopexy were included in our retrospective cohort review. A total of 22 reverse mastopexies were performed at a single institution by a single surgeon. Demographics included age (25-65 years), body mass index (25.5-41.4), and previous breast radiation (3 of 11). All the reverse mastopexies were performed secondarily to mastectomy with reconstruction to improve cosmesis. One patient had undergone unilateral autologous breast reconstruction with a latissimus dorsi flap; the remainder of the women had implant-based reconstruction. Initial short-term follow-up occurred at 1 week, 2 weeks, 1 month, and 2 months after the reverse mastopexy was performed. Follow-up phone survey revealed that all women were satisfied with their aesthetic outcomes (average preoperative vs postoperative satisfaction score: 3.9 vs 9.2; range: 0-10). Complications include localized suture abscess (n = 2), dermatologic reaction to the Dermabond skin closure tape (n = 1), and mild cellulitis 4 weeks after the procedure that resolved with oral antibiotics (n = 1). “Red-breast” syndrome was appreciated in 1 patient. No patient required reoperation. Reverse mastopexy improved cosmetic appearance and patient satisfaction in our population. Few options exist for secondary breast contouring after mastectomy with reconstruction. In comparison with fat grafting, reverse mastopexy is a single operation with predictable results without the potential to cause harvest site irregularities. In addition, reverse mastopexy offers improved scar location to the inframammary fold, which improves tissue bed quality for future nipple areolar reconstruction. Further study for long-term durability and satisfaction is indicated.