Combined mastopexy/augmentation

Abstract

In all cultures, beautiful breasts are evocative of femininity and sensuality. In the context of modern Western world, breasts have gained a considerable social and psychological importance as witnessed daily in social encounters as well as in the media and on the movie screens. Representation of breasts in fine arts reached its golden age in the era of classic Greece, where it assumed an importance that surpassed other secondary sexual organs. Centuries later, renaissance artists, heirs to Greek and Roman cultures, played a major role in disseminating classic images of beautiful breasts in paintings and sculptures. Perhaps one of the best examples of such a representation is Leonardo da Vinci's Leda and the Swan (Fig. 20.1). Flora (Fig. 20.2) is another example and was painted by Leonardo's most favorite student Francesco Melzi (1493-1570) circa 1515. Melzi was most close to Leonardo and was at his bedside when he died in France in 1519 at the court of Francis I. It is strongly hypothesized that Leonardo may have begun Flora in Florence and lef it unfinished as he of en did with many of his other paintings. It is also assumed that the model for Flora is actually the wealthy Florentine lady Mona Lisa Gioconda, whom Leonardo immortalized in the painting by the same name. The great value we attach to these two renaissance paintings, one by Leonardo and the other by his favorite student Francesco Melzi as well as to other paintings such as the Birth of Venus (Fig. 20.3) by Sandro Botticelli (1445-1510), and some three centuries later, the Turkish Bath (Fig. 20.4) by Ingres (1780-1867), are eloquent testimonies to the important role that feminine beauty and depiction of breasts play in Western societies. One may say - at least as it relates to the Western world - that our perception of what constitutes beautiful and sensuous breasts have not changed for the past 2,500 years. In contrast to breast reduction that is oft en performed for functional purposes to alleviate symptoms of discomfort and pain, mastopexy combined with breast augmentation is done for aesthetic reasons and, therefore, the appearance of the external scars is very significant for patient satisfaction. The evolution of mastopexy has hinged during the past three decades on a constant desire to reduce and improve the extent and the quality of the resulting scars. Modern era of mastopexy began in 1976 when Bartels [1] first described concentric mastopexy in an attempt to avoid the usual Wise pattern [2] of inverted-T scars. These original circumareolar procedures were oft en complicated by poorly shaped breasts, wide or thick scars, and enlarged areola, and have not gain full acceptance [3]. One may assume that the loss of popularity of circumareolar mastopexy may be as much due to poor patient selection and the method of wound closure as to the operation itself. The so-called crescent mastopexy whereby a crescent-shaped segment of skin is removed from the upper aspect of the areola does not correct breast ptosis or the breast shape to any noticeable degree and is no longer performed by the majority of surgeons. Peled in 1985 [3] and Benelli in 1990 [4] improved the technique of circumareolar mastopexy by the addition of purse string sutures that bears their names. Later, in 1990, Spear et al. [5] described certain rules to mark the patient having concentric circle mastopexy that would produce better aesthetic results. In 1990, Lejour [6] popularized the vertical scar that had been previously introduced by Lassus [7] for more advanced cases of breast ptosis. Finally in 2001, Tebbetts [8] introduced the concept of dual plane mastopexy/augmentation (that avoids any added scar) to that of standard breast augmentation incision for correction of mild to moderate degrees of glandular ptosis and breast hypoplasia. Table 20.1 shows the chronological evolution of these various techniques and Fig. 20.5 depicts the appearance of external scars from various surgical approaches. © 2009 Springer-Verlag Berlin Heidelberg.