Achieving Predictability in Augmentation Mastopexy

Background: Augmentation mastopexy remains a procedure wrought with high rates of complications and revisions given the diametrically opposing forces in this combined procedure. Thus, many surgeons remain cautious and err on a staged procedure. This article provides a dependable, predictable, and straightforward approach to a challenging operation. The technique centers on five key points, including precise preoperative markings, 8-cm vertical limbs with a broad pedicle base, limited undermining of thick skin flaps, small subpectoral implants, and movement of the nipple no more than 4 cm. Methods: Eighty-three patients who underwent augmentation mastopexy performed by a single surgeon (R.J.R) were included in a retrospective chart review following institutional review board approval. Information regarding demographics, implant contracture, degree of breast ptosis, and standard breast measurements was recorded. Operative data and postoperative complications were documented. Results: At a mean follow-up of 38 months, major complications included 16 revisions and one readmission for superficial thrombophlebitis. The majority of revisions were for scar revision or implant size change. Minor complications included two hematomas, one seroma, three T-point skin sloughs, and two minor infections. There were no instances of major flap loss or nipple loss. Conclusions: The technique described provides a safe and conservative surgical approach for one-stage augmentation mastopexy resulting in the avoidance of major pitfalls and irreversible complications of flap or nipple loss while achieving the desired results of the patient and surgeon. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.