PR51 AUGMENTATION MASTOPEXY
Authors: Codner M. A. , Weinfeld A. B. 
Published: April 2007

Introduction  Augmentation‐Mastopexy is a more complex procedure than either breast augmentation or mastopexy performed individually. Since the operation both increases breast size and corrects ptosis in one surgical procedure, the combination has been considered to be associated with increased risk of complications. Complications most commonly include ischemic related complications of the breast flaps or nipple areolar complex and loss of sensibility. While some authors have suggested a staged approach with augmentation followed by mastopexy, I prefer to perform augmentation mastopexy as a single technique which is an attractive alternative to two operations. The principles include initial insertion of the implant in either the subglandular or submuscular position followed by mastopexy which can be periareolar, vertical, or inverted‐T scar based on the degree of ptosis and size of the breast.

Methods/Technique  Augmentation is performed first so the amount of ptosis can be evaluated after the augmentation in order determine the type of mastopexy performed. The implant is placed through a periareolar incision or a vertical lower pole incision if one anticipates a vertical mastopexy scar. Implant placement is generally subglandular when sufficient soft tissue exits to provide adequate implant coverage. Care should be taken to preserve a dermal pedicle for blood supply to the nipple since subglandular dissection reduces the blood supply to the nipple areolar complex. When the breast soft tissue envelope is thin, submuscular placement is preferred for additional implant coverage. Since submuscular placement provides better coverage, there is generally less palpability and rippling. Furthermore, submuscular dissection preserves better blood supply exits to the NAC. A disadvantage of submuscular placement is increased risk of a high riding implant. The mastopexy should adequately elevate the breast to avoid a double bubble deformity is performed.

Results  Over the past 12 years, 98 augmentation mastopexies were performed. The average pre‐operative bra size was B‐cup and the average degree of ptosis was Grade II. The mean patient age was 55. Smooth round gel implants were used for 90% of the patients. 80% were placed submuscular and 20% were placed subglandular. A Periareolar mastopexy was performed in 25% of patients and an inverted T mastopexy was performed 75% patients. Periareolar augmentation mastopexy was performed commonly for the correction of tubular breast deformity.Generally, most patients were satisfied with their procedure as only 5% underwent revision for aesthetic indications. 2% patients suffered acute complications including hematoma and loss of nipple sensation. 9% suffered subacute and chronic complications including delayed wound healing, loss or partial loss of the NAC, and loss of nipple sensation. 5% patients required revisions surgery to correct the sequelae of delayed wound healing or NAC tissue loss.

Conclusions  Augmentation‐mastopexy is one of the most complex and technically demanding procedures performed in aesthetic breast surgery. Nonetheless, there is a role for the procedure due to its ability to reduce the number of procedures and provide improved breast shape. The key to success is to be aware of the most common complications and to proceed in a stepwise in order to minimize the risk of complications and maximize patient satisfaction.