Superior flap tuck in mastopexy—a novel technique to promote lift and volume

Abstract

Breast ptosis develops secondary to a pathogenic triad: progressive dermal laxity, inferior displacement of the nipple-areolar complex (NAC) and loss of superior pole fullness or “bottoming out”, leading to an aged breast appearance. Surgical mastopexy producing longevity of result is challenging. This article describes a novel superiorly based middle flap mastopexy technique via a vertical scar. Using this technique for over 5 years the senior author has produced a case series with longer lasting results compared to other techniques more commonly described. The technique is designed on a standard vertical scar pattern with a superior NAC pedicle. Glandular tissue inferior to the NAC is divided into three separate flaps, without any undermining or dissection of the lateral pillars. The central superiorly based flap immediately below the NAC is preserved, divided inferiorly and rolled back, posterior to the superior pole of the breast. It is then secured to the chest wall immediately posterior to the NAC to augment projection and conification. The lateral flaps are then brought together and secured over the top of the central flap. The skin envelope is then closed over the redistributed glandular tissue. In our experience this technique, with minimal lateral undermining and disruption of the native inferior breast architecture, produces lasting superior pole fullness. Using it in his practice, the senior author has found improved reliability and longevity of result compared to previous techniques.