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.

The “Shirt Pocket” Technique—An Alternative for Augmentation-Mastopexy

Augmentation-mastopexy is a frequent procedure with high rates of early recurrence of breast ptosis, mainly after subglandular approach. The dual-plane techniques, based on the cranial dissection of the pectoralis, is the most used, but this plane does not cover the inferior pole of the breast. Then, the possibility of a downward dissection of the muscle seems to be more reasonable to retain the implant and improve postoperative results. This study aimed to review the anatomy of the pectoralis in cadavers and the use of its downward dissection to create a pocket for breast implant as a “shirt pocket.” This maneuver was associated with a superior-based dermoglandular flap to overprotect the inferior pole. No complications were related in the postoperative period. The anatomic review showed that the “shirt pocket” is a safe option if done carefully. The technique demonstrated to be feasible and seemed to be effective, being another alternative to prevent early recurrence of breast ptosis in these procedures.

Anatomy, physiology, and pathology of body fat

Subcutaneous body fat is a distinct anatomical entity with unique physiology, metabolism, and disease. The main roles of fat are energy storage, hormone production, and insulation. Free fatty acids and glycerol can be assembled into triglycerides, and conversely triglycerides can undergo lipolysis. Insulin is the key hormone that controls this fine balance. Pregnancy is associated with increased truncal body fat and breast ptosis. Cellulite is the padded appearance of fat and there is currently no single proven treatment. Lipomas are the most common soft tissue tumour and can be treated with excision or liposuction. Lipodystrophies are disorders characterized by the selective loss of body fat and lipofilling is a useful treatment modality. Panniculitis is the inflammation of subcutaneous fat and treatment involves dealing with the precipitating cause. The plastic surgeon should be familiar with the anatomy, physiology, and pathology of fat in order to treat this wide array of adipose-related conditions.

Mastopexy

Mastopexy and mastopexy-augmentation are commonly performed surgeries to lift ptotic breasts while improving breast shape and volume. Factors that cause breast ptosis include aging, hormonal changes, and weight loss. Common surgical approaches for mastopexy utilize the periareolar, vertical, and wise techniques. All of these techniques incorporate parenchymal rearrangement in addition to skin envelope resection in order to achieve the patient’s aesthetic goals. A plastic surgeon should carefully select the appropriate mastopexy technique based on a patient’s preoperative grade of ptosis, breast shape/volume, and aesthetic goals. Many of these mastopexy techniques can be combined with implant augmentation, either as a single or two-stage procedure in appropriate patients with volume concerns. Revisions tend to be more common after implant-augmentations and may be necessary based on patient concerns and surgeon discretion. This review contains 5 figures, 5 tables, and 14 references Keywords: mastopexy, mastopexy-augmentation, breast lift, breast ptosis, vertical mastopexy, periareolar mastopexy, wise pattern mastopexy, breast surgery