Treatment of breast ptosis

Abstract

Dr. Colen: The first patient is a 29-year-old woman who underwent a periareolar subpectoral augmentation with a round, smooth saline implant 1 year ago (Figure 1). Dr. Giese, can you describe this patient's problem and how it might have been avoided? Dr. Giese: In this oblique view, it appears that the patient has a double-bubble deformity. In addition, her breast mound and the implant appear unequal; her left breast seems higher on the chest wall than the right. Figure 1 This 29-year-old woman underwent periareolar subpectoral augmentation with a round, smooth saline implant 1 year ago. She does not like the appearance of her breasts. To avoid the occurrence of a double bubble, I would not have chosen to obliterate the natural inframammary fold, if possible. The natural inframammary fold acts as a very strong sling to keep the implants properly positioned on the chest wall. Here, the implant has fallen beyond the natural portion of her breast and into the surgically created inframammary fold pocket. This patient needed an augmentation mastopexy. I like the periareolar approach and the subpectoral position with a round, smooth saline implant, but, again, I would have tried to avoid lowering or changing her natural inframammary folds. Maybe that would have meant using a smaller implant. I do not know what necessitated lowering the folds. Dr. Colen: Dr. Hammond, what would your initial approach to this patient have been? Dr. Hammond: If I felt that she needed a mastopexy, I would have performed a periareolar mastopexy without hesitation. When I am already in the periareolar incision, I use that to gain access to the breast; it is a very nice approach to the lower breast apron. The inframammary-fold incision sometimes masks the location of that fold when the implant is inserted. But from above, through the periareolar …