Secondary Mastopexy

Abstract

Augmentation-mastopexy in a single stage is a challenging operation in patients with mammary ptosis due to the simultaneous opposing forces of volume expansion with implants and skin envelope tightening. Augmentation-mastopexy is defined as “secondary” when the patient has undergone previous breast surgery (e.g. augmentation alone, mastopexy alone, previous augmentation-mastopexy, breast reduction, lumpectomy, excisional biopsy, or mastectomy with implant-based reconstruction). Augmentation-mastopexy is considered “revisional” when performed to correct an early or late problem from previous augmentation-mastopexy. Secondary augmentation-mastopexy is very common in the patient who has previously undergone breast augmentation and had aging of her breasts. Various incision designs are available to address laxity in different aspects of the breast and positions of the nipple areola complex. Mastopexy skin incisions that can be used during secondary augmentation-mastopexy include crescent, circumareolar, circumvertical (“owl”), circumvertical with short horizontal wedge at the inframammary fold (“owl with feet”), Wise, “sailboat, " or “smile.” Patients with prior breast implants may also require capsule surgery, which should be approached with caution. In this chapter, the authors outline patient indications, preoperative preparation, and surgical techniques to achieve optimal outcomes with secondary augmentation-mastopexy. The focus of the chapter is on mastopexy techniques on patients who have had a previous augmentation and/or mastopexy.