Mastopexy with Auto-augmentation

Abstract

The treatment of the ptotic breast can be complex and often a variety of techniques would be considered appropriate and the final operative approach is determined in part often by patient expectations for the final outcome. When a mastopexy is deemed necessary, this can be performed alone or in conjunction with placement of a breast implant. Mastopexies alone have historically been inadequate to achieve long-term persistence of volume in the upper pole. However, there are patients in whom an augmentation with the mastopexy may not be appropriate or necessary. Patients desiring a more natural upper pole or desire significant volume reduction would not be appropriate for an augmentation. Likewise, there are patients that want to avoid or simply refuse to have an implant placed. When a mastopexy is performed without the use of an implant, a unique procedure that addresses the upper pole without the use of an implant is the focus of this chapter. The mastopexy with a lower island flap auto-augmentation involves the transposition of lower pole breast tissue into the upper pole of the breast to improve distribution of the breast tissue into a more desirable location. This not only improves upper pole fullness, but likewise unloads the lower pole of the breast, reducing the likelihood of lower pole failure over time. In this chapter, the authors focus on perioperative decision making and surgical technique in performing a mastopexy with auto-augmentation. The decision on the surgical approach and design of the mastopexy is based on a host of clinical findings, including the soft tissue characteristics, the distribution of the ptotic breast volume, the quality of the parenchyma and skin, and the patients anticipated results. The impact of these decisions on preservation of blood supply and the ultimate safety of the procedure will be highlighted in this chapter. The ability to create improvement in upper pole fullness without the use of an implant and long-term control of the lower pole shape in a consistently safe manner are hallmarks of a successful mastopexy with auto-augmentation procedure.