Mastopexy Procedures Research Articles

Is Half a Century-Based Suturing Pattern Worth the Upgrade? Evaluating a Novel Suturing Technique: Knot Less is More.

The aesthetic outcomes of wise pattern-based breast reduction and mastopexy procedures are significantly influenced by the final scar quality, which is directly impacted by the suturing technique. Over the past century literature on suture placement has remained limited, with little advancement in tissue approximation methods. The success of conventional suturing depends on the surgeon's skills and expertise and the selection of suture material. Proper deep placement of absorbable sutures is essential to reduce risks; in fact, incorrect placement can lead to complications such as poor scar quality and negative psychological effects on the patient, and occasionally more severe issues like delayed wound healing. Our experience with a running suturing technique for wise pattern-based mammoplasty indicates that reducing the number of knots can lead to a better overall experience for both the patient and the surgeon. This technique may improve aesthetic results, decrease complications, and streamline the surgical process.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Structural Mastopexy: Volume Displacement in Breast Reshaping.

Although in breast reshaping, the restoration of a suitable mammary cone is the main goal of the procedure, long-lasting upper pole fullness preservation is the most common weak point of all mastopexy. Mastopexy is a challenging procedure, and a surgical procedure to create desirable long-lasting results has not been well standardized. In this paper, the authors report their experiences in structural mastopexy procedures, describing three different adipo-glandular flaps, each repositioned as auto-prosthesis to reshape upper pole contour in patients affected by a severe degree of breast ptosis. A 6-year retrospective iconographic-chart and review was performed on 89 patients undergoing mastopexy between January 2016 and December 2021. Surgical candidates reported grades 2 and 3 of ptosis following Regnault classification. Minimum follow-up was 24 months. Pre- and postoperative data for all patients were collected in the same standard conditions. 89 patients affected with bilateral breast ptosis were included in the study, for a total of 178 breasts. Patients' mean age at the time of surgery was 40.45 years, ranging between 28 and 59 years. Follow-up ranged between 2 and 6 years with an average of 47.13 months. Out of 89 patients, 50 underwent general anesthesia, and the remaining 39 underwent local anesthesia. Among the 178 treated breasts, 10 (17.8%) experienced minor complications: No major complications were reported. Autologous tissue displacement, collecting parenchyma wherever surplus can be recruited, permits the transfer of extra tissue to the lack of volume, recontouring satisfactory breast shape and ensuring long-lasting results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Four-Layer Wound Closure Technique with Barbed Sutures for Inframammary Fold in Mastopexy Augmentation.

The inframammary fold (IMF) is an important landmark in breast aesthetic surgery. In augmentation mastopexy procedures, secure and accurate placement of the IMF is essential to aesthetic outcomes and to allow the new IMF to heal in the correct position without displacement. The authors present a simple and efficient four-layer wound closure technique using barbed sutures for closure of the repositioned IMF in augmentation mastopexy procedures. This method was previously described by the first author for reset of the IMF in breast augmentation surgery and has been adapted to the longer IMF incision in augmentation mastopexy procedures. A retrospective review was undertaken of 335 patients who underwent bilateral breast augmentation mastopexy procedures with a Wise pattern technique at a single unit. The newly reset IMF was closed using barbed sutures and a four-layer closure technique. There were no cases of complications related to wound healing or wound dehiscence. One patient required explantation for an infected implant. The four-layer wound closure technique with barbed sutures provides a quick and efficient method for accurate closure of the newly reset IMF, with positive outcomes related to wound healing. Secure and accurate placement of the inframammary fold is crucial in augmentation mastopexy procedures. The use of a four-layer wound closure technique with barbed sutures provides an efficient method for accurate closure of the newly reset inframammary fold. This method was previously described by the first author for reset of the IMF in breast augmentation surgery and has been adapted to the longer IMF incision in augmentation mastopexy procedures. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Long-Term Satisfaction with Breast Augmentation and Augmentation Mastopexy in the Latin American Population.

The primary objective of this study was to determine the long-term satisfaction levels of women who have undergone breast augmentation and augmentation mastopexy procedures, while identifying the factors influencing patient satisfaction. A self-reported retrospective case study design was used to collect data from women with breast implants. The study employed a survey that included demographic information, preoperative diagnosis, implant details, and patient-reported outcomes measured using the Breast-Q Instrument, which evaluates satisfaction with breasts, self-esteem, sexual well-being, and physical symptoms. Statistical analyses were conducted to identify correlations and differences in outcomes between the different variables. The survey was completed by 1022 women from 19 countries, with Chile, Mexico, and Colombia being the most represented. Augmentation was performed on 72.2% of the patients, while 27.7% underwent augmentation mastopexy. Patient satisfaction with breast size and shape varied significantly between the two procedures, with patients undergoing augmentation mastopexy showing less satisfaction. In addition, patients who were unaware of their implant shape or placement reported lower satisfaction scores. The study also found that patient satisfaction decreased over time in the augmentation mastopexy cases and that patients with high body mass index had lower satisfaction. Augmentation mastopexy in patients with breast ptosis yields lower satisfaction than augmentation alone. Dissatisfaction escalates with overweight/obesity (BMI), post-surgery time, and misinformation. Implant pocket (pre-vs. subpectoral), shape (round vs. anatomical), and size did not impact satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Round Autoprosthesis: Use of Adipodermaglandular Flap in T Scar Mastopexy.

This study focuses on the use of round or anatomically shaped breast autoprosthesis with different volumes prepared from the central and lower poles of the breast. The technical details and surgical outcomes for patients with varying degrees of breast ptosis are discussed. This study involved 42 patients who underwent the Wise-pattern superior pedicle mastopexy procedure using the adipodermaglandular island flap technique. The research spanned from December 2017 to August 2022. The study participants had not previously undergone breast surgery, did not desire breast implants, and exhibited grade 2 and 3 breast ptosis according to the Regnault Classification. Age and preoperative breast measurements of the patients were recorded for subsequent analysis. Measurements, such as the distance from the nipple-areolar complex to the inframammary fold and the distance from the suprasternal notch to the nipple-areolar complex, were taken both before the surgery and one year after. A systematic process was followed to identify acute and subacute complications during the postoperative follow-up period. This study involved 42 patients with a mean age of 33.9 years (range: 23-49 years). These procedures were conducted between December 2017 and August 2022. The average SN-N distance before surgery measured 26.7cm (range: 24-33cm). One year after surgery, the average SN-N distance was 23.1cm (range: 21.3-24.8cm). The follow-up duration for the examined cases ranged from 12 to 18 months on average. Among the observed cases, delayed wound healing was noted in one instance, venous insufficiency of the nipple in another, and fat necrosis in a third case. The overall complication rate in the group was determined to be 7.1%. In our study, the detachment of dermal connections at the level of the inframammary fold (IMF) and the smooth advancement of the flap in the form of an "island flap" made a contribution to upper pole fullness. Furthermore, we hypothesize that the fusion of the medial and lateral ends of the flap will enhance tissue integration during the healing process, promoting compatibility between the autoprosthesis tissue and breast tissue. Regarding the rates of complications described, classic mastopexy techniques have exhibited similar rates in our findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparative Analysis of Lower Island Flap Transposition (LIFT) in Wise-Pattern Mastopexy: Does It Improve Upper Pole Fullness and Breast Harmony?

Utilization of autologous parenchymal flaps aims to attain enduringly favourable outcomes and uphold volume in the upper breast pole after mastopexy procedures. The objective of this study was to juxtapose and scrutinize postoperative upper pole fullness, upper/lower pole ratios, occurrences of bottoming-out deformity, and complication rates between two patient cohorts: those who underwent the wise-pattern superior pedicle mastopexy with the LIFT technique and those who underwent the conventional wise-pattern superior pedicle mastopexy. All the patients in this study were appropriately categorized as primary patients, signifying their lack of any prior breast surgery history. These individuals presented with grades II and III breast ptosis on both breasts, ranging from moderate to severe deformities per the Regnault classification. Importantly, all patients uniformly expressed their desire to achieve a firmer breast appearance without recourse to using breast implants. The patients' ages and preoperative breast measurements were recorded for analysis. Measurements, including the distance from the NAC to the inframammary fold and from the sternal notch to the NAC, were systematically measured both before the surgery and at the 1-year postoperative mark. The upper and lower pole ratios, defined by Mallucci and Branford, were found to be 45.22% ± 2.20% and 54.88% ± 2.20%, respectively, within the LIFT group. In 13 instances, a lower pole distance exceeding 55% indicated a potential bottoming-out deformity (value lower than 45%/55% ratio or 0.818). Conversely, within the control group, the upper and lower pole ratios were determined as 43.22% ± 2.80% and 56.88% ± 2.80%, respectively. These findings demonstrated statistical significance. Notably, in 39 cases within the superior pedicle wise-pattern mastopexy group, a lower pole distance surpassing 55% (value lower than 45%/55% ratio or 0.818) suggested a leaning towards a bottoming-out deformity (p: 0.003). A postoperative period of at least 12 months was essential to discern the emergence of upper pole fullness and the potential development of bottoming-out deformities. Among the cases within the LIFT group, 93% exhibited successful attainment of upper pole fullness, while in the control group, this outcome was achieved in 82% of cases (p>0.05). Implementing the LIFT technique alongside the wise-pattern superior pedicle mastopexy decreases the occurrence of bottoming-out deformity after 1 year. Although there is no statistically significant difference, the LIFT flap technique has contributed to some extent to upper pole fullness. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mastopexy under local anesthesia: A case series and systematic review

ABSTRACT Background: Mastopexies are most frequently executed under general anesthesia. Local anesthesia (LA) on the breast tissue could make it possible to perform this type of operation without the need for (intravenous [IV]) sedation. This case series analyzes the procedure, operative pain scores, and postoperative outcomes of mastopexies performed under LA. The aim of this articles is to determine the feasibility of a mastopexy procedure under LA without the need for IV sedation. Methods: All patients, who underwent a mastopexy under LA, were retrospectively contacted and asked to fill in a questionnaire after informed consent. A systematic review was performed to identify all research available on this procedure. Results: A total of 51 patients, with an average age of 40.7 years, filled in the questionnaire. The mean Numeric Rating Scale (NRS) scores during the operation ranged from 3.47 (first intradermal injections) to 3.05 (subcutaneous injections) to 1.07 during the operation itself. Forty-five patients confirmed they would undergo the operation under LA again. Six patients did not want to undergo the same operation under LA anymore. Four patients had minor postoperative complications. Articles on mastopexy under LA without any type of IV sedation could not be found. Conclusions: This case series illustrates that mastopexies can be safely performed under LA. The peroperative and postoperative pain scores were low and patient satisfaction was high. This first-ever case series on mastopexy under LA without sedation shows promising results, which need to be confirmed in future studies. Level of Evidence: Level IV, case series.

Practice Profile of Practicing Plastic Surgeons: A 20-year Review of Plastic Surgery Statistics.

Evaluation of practice patterns by American Board of Plastic Surgery (ABPS) diplomates allows for a greater understanding as to how the field is progressing. Understanding evolving procedural trends can give insight into plastic surgeons' subspecialty focus and influence resident training to prepare them for future practice. American Society of Plastic Surgeons member only projections for aesthetic and reconstructive procedures were reviewed from 1999 to 2018 in 5-year increments to identify shifts in frequency between the beginning (1999-2003) and end (2014-2018) of the timeframe. Tracer utilization for all four ABPS modules were also examined between 2014 and 2018. Descriptive statistics were performed to identify significant changes (P < 0.05) in subspecialty focus and procedure trends. Annual procedure incidence between 2014 and 2018 was compared with that between 1999 and 2003. The annual number of procedures more than doubled from 3,244,084 to 6,628,082. Among reconstructive procedures, there was a statistically significant increase in the number of breast reconstruction, breast implant removal, and maxillofacial surgery procedures, and a statistically significant decrease in the number of procedures focused on reconstruction of birth defects, burn injuries, and hand anomalies. In aesthetic surgery, significant increases were seen in the number of augmentation mammoplasty, abdominoplasty, and mastopexy procedures, with significant decreases in the number of blepharoplasty and rhinoplasty procedures. Understanding the changing practice patterns of ABPS diplomates is essential to define the direction that our specialty is taking over time, and to guide program directors in plastic surgery on areas of focus for appropriate training of plastic surgeons.

Breast Explantation With Simultaneous Mastopexy and Volume Restoration: An Analysis of Clinical Outcomes and Prospective Quality of Life.

An increasing number of patients are undergoing explantation to alleviate symptoms attributed to the presence of a prothesis or dissatisfaction with the appearance of their breasts. The authors aim to evaluate the clinical effectiveness and quality of life (QoL) of simultaneous explantation, capsulectomy, and mastopexy for patients requesting implant removal. Two hundred sixty-two simultaneous explantation, capsulectomy, and mastopexy (ECM) procedures were performed in 131 patients from 2009 to 2019. Prospective QoL assessment was administered for all patients. Inclusion criteria included a minimum postoperative follow-up of 6 months and completion of a practice-generated patient reported outcomes (PRO) questionnaire. Wilcoxon signed-rank test was performed to compare changes in QoL scores. Mean follow-up and BMI were 23 months (6 months to 8 years) and 24.8 kg/m2 (18-34 kg/m2), respectively. Mean age was 48.3 years (26-75 years). Autologous fat grafting was performed simultaneously in patients 47.3% (n = 62). The complication rate was 3.8% (n = 10 breasts) in 9 patients (6.9%). The overall reoperation rate was 7.3% of procedures (n = 19 breasts) and 9.2% of patients (n = 12), including secondary autologous fat grafting (11.3%, n = 7). PRO results demonstrated a significant improvement in all QoL domains, including physical well-being (P < .005), psychological well-being (P < .005), sexual well-being (P < .005), breast shape (P < .005), and breast appearance (P < .005). With respect to breast implant illness symptoms, 59 patients (88.1%) noted reduced pain, myalgias/arthralgias, and fatigue after ECM. This study presents an effective paradigm to manage implant removal through simultaneous explantation, capsulectomy, and mastopexy with acceptable clinical outcomes and a significant improvement in QoL and breast aesthetics.

Safely Shaping the Breast After Implant Removal and Total Intact Capsulectomy Using the Mammary Imbrication Lift and Fixation Technique.

Implant-based breast augmentation is one of the most popular plastic surgery procedures performed worldwide. As the number of patients who have breast implants continues to rise, so does the number of those who request breast implant removal without replacement. There is little in the current scientific literature describing total intact capsulectomy and simultaneous mastopexy procedures. Here, the authors present their current method using the mammary imbrication lift and fixation technique after explant and total capsulectomy. Between 2016 and 2021, a total of 64 patients (mean age: 42.95 years; range, 27-78 years) underwent the described mammary imbrication lift and fixation technique with bilateral breast implant removal and total capsulectomy. Mean follow-up was 6.5 months (range, 1-36 months). Postoperative complications included minor cellulitis in 1 patient (1.6%), late onset hematoma with infection in 1 patient (1.6%), fat necrosis and pulmonary embolism in 1 patient with prior history of thromboembolic events (1.6%), and breast scar irregularity in 4 patients (6.2%) who required subsequent minor scar revision or steroid injections. Two patients (1.6%) underwent revision surgery with bilateral breast fat grafting to improve shape and add volume. The mammary imbrication lift and fixation technique described here can safely and simultaneously be performed with a total intact capsulectomy and explant procedure. This technique avoids wide undermining, intentionally opening the capsule, performing subtotal capsulectomy, and preserving blood supply to the breast tissue and nipple with low complication rates.

Reply: Do High-Projection Shaped Breast Implants Offer An Effective Alternative to Augmentation/Mastopexy?

We appreciate Dr. Swanson’s letter regarding our article, “Breast Augmentation with Microtextured Anatomical Implants in 653 Women: Indications and Risk of Rotation.”1 We agree with Dr. Swanson that breast augmentation with high-projection anatomical implants cannot replace the mastopexy procedure. It would be wrong to offer a breast augmentation without a mastopexy to patients with severe ptosis who wish a substantial lift of the nipple-areola complex. However, we do believe that breast augmentation with anatomical implants is a valuable alternative to augmentation-mastopexy in a subgroup of women with glandular ptosis and a low position of the nipple-areola complex. These patients can benefit from smaller scars, less extensive surgery without the risk of nipple necrosis,2,3 and a lower cost but at the expense of lowering the inframammary fold.4 We attribute the benefit of anatomical implants in this selected group of patients with a low position of the nipple-areola complex to the shorter arch from the lower pole of the implant to the point of maximum projection compared with round implants, which limits the lowering of the inframammary fold.5 Our study is limited by the retrospective design with the lack of a standardized measurement tool, but it is strengthened by the large sample size, and it provides the readers with data on the reoperation rate due to malrotation of the implant. Dr. Swanson correctly states that our discussion of the beneficial properties of anatomical implants is based on first principles. We thank Dr. Swanson for adding the horizontal line to Figure 3 from the original article, as we think it illustrates the elevation of the nipple very well. On the left preoperative photograph, the line tangent is on the nipples’ superior border, whereas the line tangent is on the nipples’ inferior border on the right postoperative photograph. More importantly, there is less slack and more “breast” below the level of the nipple even though this comes at the expense of lowering the inframammary fold. We hypothesize that this type of patient is better treated with anatomical implants than with round implants if the augmentation is not accompanied by a mastopexy. However, this hypothesis needs to be tested against a control group before a firmer conclusion can be made. Regarding the implant rotation rate, we used the rate of reoperation, which was free of charge for the patients. We did not use diagnostic imaging to detect implant rotation because of the retrospective design of our study. We found an approximately 3 percent rotation rate requiring reoperation for microtextured implants, which is comparable to the incidence reported in the literature for macrotextured implants.1,6–8 As Dr. Swanson points out, this rate is almost certainly an underestimation as some patients might not detect a malrotation or may not want to go through revisional surgery even though this is free of charge. Sieber et al.9 reported a rotation rate of 42 percent when using high-resolution ultrasound but only 5 percent were clinically detectable. This vast difference between the imaging and the clinically observable malrotation makes it arguably more clinically relevant for both surgeons and patients to use the rate of clinically observable malrotation or the reoperation rate, when considering anatomical implants. We agree with Dr. Swanson that since the submission of our manuscript there have been more reported cases of breast implant–associated anaplastic large-cell lymphoma and the link to macrotextured implants is stronger.10 However, the current risk estimates are still very uncertain due to the low number of cases and the poorly reported medical history of each case.11 In our experience, patients are tolerant to the low risk of breast implant–associated anaplastic large-cell lymphoma associated with Siltex (Mentor, Irvine, Calif.) texturization, and most of the patients in our clinic prefer round Siltex implants over round smooth implants. In conclusion, we agree with Dr. Swanson that, as we mentioned in the Discussion section of our article, breast augmentation with high-profile anatomical implants cannot replace augmentation-mastopexy. We agree that women who emphasize lifting the nipple should be offered an augmentation-mastopexy. However, we suggest breast augmentation with high-projection anatomical implants is a valuable alternative to augmentation-mastopexy in a selected group of women with glandular ptosis who prefer a lowering of the inframammary fold over the scars that accompany a mastopexy. DISCLOSURE The authors have no financial interest in any of the products or devices mentioned in this communication. Tim K. Weltz, B.M.Sc.Andreas Larsen, M.D.Mathilde N. Hemmingsen, M.D.Mathias Ørholt, M.D.Louise E. Rasmussen, B.M.Sc.Department of Plastic Surgery and Burns TreatmentCopenhagen University HospitalRigshospitalet Peter S. Andersen, M.D.Faye Sarmady, M.D.Department of Plastic Surgery and Burns TreatmentCopenhagen University HospitalRigshospitaletAmalieklinikken Jens J. Elberg, M.D.Amalieklinikken Peter V. Vester-Glowinski, M.D., Ph.D.Department of Plastic Surgery and Burns TreatmentCopenhagen University HospitalRigshospitalet Mikkel Herly, M.D.Department of Plastic Surgery and Burns TreatmentCopenhagen University Hospital RigshospitaletDepartment of Immunology and MicrobiologyFaculty of Health SciencesUniversity of CopenhagenCopenhagen, Denmark

Risk Factors for Postoperative Complications Following Aesthetic Breast Surgery: A Retrospective Cohort Study of 4973 Patients in China.

The popularity of aesthetic breast surgery in China results in greater demand for assessing risk factors for complications and mortality. To determine the incidence and independent risk factors for postoperative complications following aesthetic breast surgery in China. A retrospective cohort study on 4973 patients who had aesthetic breast surgery between 2012 and 2021 was performed. Postoperative complications include minor complications (incision healing impaired, hematoma, or fat liquefaction) and surgical site infection (SSI), which were recorded within 30 days after surgery. The follow-up time was expanded to 1year only after prosthesis implantation procedures. Potential risk factors including age, weight, length of hospital stay, operation time, volume resection, incision location, and other clinical profile information were evaluated. Among 4973 patients who underwent aesthetic breast surgery, the minor complication rate was 0.54%, and SSI was 0.68%. Augmentation with prosthesis implantation had the highest SSI rate (4.23%), which was significantly associated with increasing age (relative risk [RR] 1.12; P < 0.01) and periareolar incision (RR 5.87, P < 0.01). After augmentation with autologous fat transplantation, postoperative antibiotic use (RR 6.65, P < 0.01) was an independent risk factor for SSI. After adjusting for weight, volume resection over 1500 g (RR 14.7, P < 0.01) was an independent risk factor for SSI of reduction-mastopexy surgery. The complication rate of reduction mammaplasty (1.01%) and gynecomastia correction was lower (0.75%), and there was no record of complication in mastopexy procedures (n = 161). The incidence of postoperative complications following aesthetic breast surgery is low. Risk factors for complications mainly include increasing age, perioperative antibiotic use, periareolar incision, and extensive volume resection. Much more attention should be focused on those high-risk patients in clinical practice to decrease breast infection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Single-Stage Suction-Assisted Lipectomy with Dermal Mastopexy: An Alternative Procedure in Repeated Reduction Mammaplasty with Questionable Nipple-Areola Complex Vascularity.

A majority of malpractice claims in plastic surgery involve complications following breast surgery.1 Nipple-areola complex necrosis is a devastating complication in reduction mammaplasty secondary to compromised vascular supply. The risk of nipple-areola complex necrosis increases in repeated reduction mammaplasty, particularly when the previously used technique is unknown and operative reports are unobtainable. The appropriate technique for repeated reduction mammaplasty remains controversial, as several approaches have been advocated in the literature.2 Many of these techniques involve full-thickness incisions and wide tissue excision for volume reduction, and thus carry the intrinsic risk of nipple-areola complex necrosis due to violation of the underlying vasculature. Suction-assisted lipectomy with dermal mastopexy is a novel technique for repeated reduction mammaplasties to preserve nipple-areola complex vasculature and sensation. An inverted-T de-epithelialization is marked preoperatively (Fig. 1). Each breast is instilled with 1 liter of tumescent solution consisting of 1 liter of Ringer’s lactate with 1:1,000,000 epinephrine and 50 cc of 1% lidocaine. De-epithelialization is undertaken while the breast is tumesced, and the raw surface provides access points for suction-assisted lipectomy. Liposuction is accomplished using a MedGyn Rigid Currette size 7 (MedGyn Products, Addison, Ill.). After suction-assisted lipectomy, dermal mastopexy is completed with interrupted sutures, imbricating the dermal surface.Fig. 1.: Intraoperative views of suction-assisted lipectomy with dermal mastopexy. The midline axis, inframammary fold, nipple-areola complex, distance from sternal notch to nipple, and incision lines were marked along the breast (left). There was much less excess skin in repeated reduction mammaplasties than in primary reductions, and the nipple-areola complex rarely had to be moved more than a couple of centimeters. De-epithelialization of the breast then provides access for suction-assisted lipectomy (right).Eleven suction-assisted lipectomy with dermal mastopexy procedures were performed from 2008 to 2019. The median patient age was 43 years (±9.9 years) and the median time between reductions was 14.5 years (±5.9 years). Average total volume reduction per breast was 800 cc (±200 cc). There were no intraoperative complications in the cohort. Two patients had postoperative complications of wound dehiscence requiring eventual return to the operating room for hypertrophic scar revision. After a follow-up period of 6 months, all patients reported intact nipple-areola complex sensation, and nipple-areola complex vasculature was preserved in all cases. All patients reported decreased symptoms associated with macromastia, such as rashes and back pain. All patients reported satisfaction with their final breast size and symmetry. Aside from aesthetic considerations, any breast reduction must also take oncologic considerations into account. Preoperative imaging was performed in most of our patients to identify malignancies and serve as a comparative baseline for future mammograms. Reduction mammaplasty with liposuction has been shown to trigger deep intraparenchymal calcification development.3 Most of these changes are macrocalcifications, however, and are rarely confused with malignant-appearing microcalcifications when reviewed by experienced radiologists.3 The evidence suggests that liposuction with dermal mastopexy does not interfere with detection of malignancies any more than traditional techniques.4 In this small review, we show that repeated reduction mammaplasty can be as complication-free as the initial reduction with nipple-areola complex preservation. Furthermore, this approach can be critically useful in the setting of unknown prior surgical techniques. Limitations to our study include our small sample size and lack of a standardized comparison group. Furthermore, while suction-assisted lipectomy is a favorable approach for breasts composed largely of fatty tissue, this technique is not appropriate for breasts composed of mostly glandular tissue.5 Therefore, suction-assisted lipectomy with dermal mastopexy may offer a significant advantage for older patients due to the progressive fatty involution of breast tissue with age. DISCLOSURE The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article. No funding was received for this work.

Auto-Augmentation Mastopexy: Inferiorly Based Parenchymal Flap Technique and Evaluation of Outcomes Using BREAST-Q After 151 Consecutive Patients.

Mastopexy is one of the most performed annual plastic surgery procedures; hence, various techniques are described over the last decades. It varies from simple skin incisions to internally shaped pedicle designs. In this study, the authors present their modified auto-augmentation mastopexy technique and the resulting patient satisfaction. For this retrospectively conducted study, 151 female patients were included. The average age was 40.6 years (range, 27-72 years). All patients underwent auto-augmentation mastopexy which is a combination of a superior pedicle for the nipple-areola complex and an inferiorly based soft-tissue flap which is shaped like an implant. Additionally, the BREAST-Q for Reduction/Mastopexy was used to analyze patient-reported satisfaction and quality of life after mastopexy. All breast corrections were successfully performed. General complication rate was 9%, and no major complication was observed. In two patients, local surgical revision due to hypertrophic scarring and nipple asymmetry was necessary. Analysed surveys of the BREAST-Q showed statistically significantly improved results. Depending on the breast-shape and the grade of ptosis, the selection of mastopexy technique is crucial. Our described mastopexy procedure is a safe and easily reproducible technique for almost all shapes of ptotic breasts which fulfill patient desires as well as aesthetic satisfaction and quality of life. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Split Inferior Pedicle: The 1-Stage Augmentation Mastopexy for Grade 3 Ptosis.

In this article, the authors describe the 1-stage surgical technique that has been used by the senior author since 1990 for all his primary grade 2 and grade 3 augmentation-mastopexies. The article provides a safe, simple, and reproducible approach to a challenging procedure, one that tends to be the most litigious in aesthetic breast surgery. The key points of this technique are simple preoperative markings; the augmentation is performed with a true submuscular placement of smooth implants; and the mastopexy is performed with an inferior pedicle technique with unlimited skin flap undermining and no limitation of nipple elevation. Seventy-eight consecutive cases of augmentation mastopexy performed since 1999 by a single surgeon (V.S.) using the same technique were reviewed. The age range was 26-62 years old; the range of implant volume was 150-375 cc; and the follow-up time period was from 1 year to 22 years. After an extensive patient case review, the authors enforce true extended submuscular augmentation (TESMA) as a reliable augmentation technique that can be used as the first procedure in any grades 2 and 3 ptosis, 1-stage augmentation-mastopexies including bariatric cases. The authors believe that the split inferior pedicle for the mastopexy in combination with the TESMA is a breakthrough approach that eliminates the second stage for any augmentation mastopexy procedure. No major complications such as nipple necrosis, implant bottoming, malpositioning, or extrusions were observed. It is a safe, simple, and reproducible procedure. Level of Evidence: 4

Single-Staged Mastopexy With Augmentation: A Retrospective Review of 260 Patients in a Single Surgeon Practice

Mastopexy has become a widely popularized procedure across the country over the last 20 years. Women have seen the benefits of various forms of breast lifts to correct breast ptosis. While older teachings focused on mastopexy and augmentation as separate, staged procedures, many centers now perform both simultaneously. Our center primarily performs mastopexy procedures with simultaneous augmentation with implants, and we reviewed 260 patient charts to examine complications when compared to mastopexy alone. Complications reviewed include the following: hematoma formation, incision openings, and revision surgeries. Our data showed only minor rates of hematoma formation, incision openings, and revision surgeries with a negligible difference between the 2 groups. Patients in both groups overall had few surgical complications. Patients undergoing mastopexy with simultaneous augmentation had similar rates of complications when compared to patients with mastopexy alone. Many previously believed that simultaneous augmentation with mastopexy would place too much tension on the mastopexy incisions due to the rapid breast volume increase. However, with no significant changes in complications between the groups, it is clear that surgical technique and planning has improved to allow this to be a safely performed single-staged procedure. Overall, we had minimal complications and show that mastopexy with simultaneous augmentation is safe for patients who desire these procedures.

Breast Equalization Augmentation: The Use of Ultrasonic Assisted Liposuction for Correction of Primary Breast Asymmetry with Bilateral Augmentation.

The purpose of this study was to determine the effectiveness of using ultrasonic assisted liposuction (UAL) to achieve sufficient breast symmetry allowing for the use of same sized implants in patients presenting for elective breast augmentation surgery. A retrospective review was performed of patients presenting for augmentation mammoplasty with breast asymmetry who underwent ultrasonic assisted liposuction in combination with implant augmentation. Pre-operative differences in breast volumes were determined using water displacement, and these measurements were compared to final lipoaspirates required to achieve symmetry. To estimate the volume of lipoaspirate required, we suggested to aim for twice the volume difference obtained by water displacement. The success of the procedure was measured by the ability to use the same size implants bilaterally. A total of 35 patients were included in this review. In 85% of patients, UAL was sufficient to permit the use of equally sized implants bilaterally. However, when different sized implants were required, the size difference between implants was not greater than 25cc. The UAL was also effective in correcting minor ptosis and nipple position. The main observed disadvantage was prolonged bruising and swelling. The use of UAL for correction of primary breast asymmetry with bilateral breast augmentation allows balancing of breast tissue volumes and the use of same size implants and eliminates the need for balancing mastopexy procedures. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Three-Flap Mastopexy with Reduction or Augmentation.

Many authors have studied breast ptosis and made contributions to the search for a procedure that allows its correction with long-lasting results and minimal scars. Collective evolution has allowed us to reach the point where we are today and will allow us to continue improving techniques in the future. The mastopexy procedure that we have used for the last 11 years, resulting from our surgical practice and countless observations at conferences, is a versatile procedure, applicable to different types of breasts and mastopexies with and without reduction or augmentation. Analysis and the clinical review of the patients and the records of the mastopexy cases that we operated on using the technique from January 2009 to March, 2020, are presented here. Using a periareolar approach for grade I ptosis and an inverted "T" approach for more severe ptosis, the excess skin is removed, and three flaps of breast tissue, superior, medial and lateral, are carved. A retromammary dissection is performed to anchor the end of the flaps, medial and lateral, to the pectoral aponeurosis, followed by invagination of these flaps to concentrate the breast tissue in the upper and central area of the breast. Closure of the wound is then performed, transforming its excess length into a short horizontal one, into the inframammary grove. Sixty-seven female patients, between 36 and 59 years old, underwent this procedure. Complications included hematoma (4%), overcorrection (4%), dehiscence (3.3%), residual ptosis (2.7%), pathological scarring (2.7%) and rotation folds (2%). Maximum follow-up was 8 years 2 months, mean follow-up 2 years 9 months, with satisfactory results for the patients and surgeon. The mastopexy procedure that we present here is a versatile technique, which can be applied to most cases requiring correction of ptosis. It provides the breast with proper shape, size and location with fewer scars. It is a logical, safe, efficient, reproducible procedure, which is easy to learn. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The 10-Year Experience with Volume Distribution Mastopexy: A Novel, Safe, and Efficient Method for Breast Rejuvenation.

Recurrent ptosis may occur after mastopexy procedures over time. The volume distribution mastopexy technique provides breast lifting with projection enhancement and maintains breast suspension. Since 2010, 50 patients underwent volume distribution mastopexy procedures. The technique consists of a superior or superomedial pedicle, dissection of a Würinger-septum-based chest wall flap, suspension of the flap to the pectoralis major muscle using a prosthetic mesh, gland suture to the mesh, and fat grafting if required. A prospective study was conducted. Nipple position and length of the lower pole distance of the breast were noted. Patient satisfaction and results evaluation were reported using a Likert scale. A Vicryl mesh was used in the first 23 patients and a mixed polyester/Vicryl mesh was used in the following 27 patients. Wound dehiscence occurred in one patient. At an average follow-up of 3 years, nipple position remained stable in position, but lower pole distance elongation was observed in five patients (20 percent) and in one patient (3 percent) who had Vicryl mesh and mixed mesh respectively (p < 0.05). Only four breasts (4.7 percent) demonstrated significant lower pole elongation over time (>15 percent), all in the Vicryl mesh group. Worth noting, both the patients and the independent evaluators provided high ratings of the result of 4.7 and 4.6, respectively, on a Likert scale. The volume distribution mastopexy technique repositions the ptotic gland with a mesh to suspend the breast gland and to maintain the lifting effect. However, the synthetic mixed mesh proved to be significantly more effective in achieving this goal. Therapeutic, IV.

Breast Lift with and without Implant: A Synopsis and Primer for the Plastic Surgeon.

SummaryBreast ptosis is a common occurrence following weight loss, pregnancy, and breastfeeding, or as a consequence of normal aging. This results in loss of a youthful shape and contour of the breast, with a change in the position of the nipple–areolar complex. Mastopexy can restore this youthful appearance and transpose the nipple–areolar complex to a more aesthetic position on the breast. Various techniques exist that address the skin and parenchyma of the breast and are chosen based on the degree of ptosis and skin laxity, as well as the patient’s goals. These techniques all differ in scar burden and risk profile. Additionally, this can be done simultaneously or in a staged manner. In this literature review, we aim to provide an overview of mastopexy procedures, with and without augmentation. Further, we aim to detail recent advancements in technical approaches, and delineate common complications in certain patient demographics. To this end, we performed a literature search with a medical librarian, using PubMed/Medline to identify pertinent literature. In the context of the review, we discuss important considerations in patient selection and counseling to set expectations and ultimately, optimize surgical outcome and patient satisfaction.