Shaping the Breast: Augmentation Mastopexy

Abstract

Although there has been significant controversy over the years as to the appropriateness of performing a breast augmentation simultaneously with a mastopexy, significant data have emerged demonstrating the effectiveness of this procedure in the appropriately selected patients. There is no doubt that when performed well, the ability to truly “shape” the breast and produce aesthetically pleasing outcomes has led to the increasing popularity of this procedure in the experienced breast surgeon’s hands.

Many patients need more than simply volume to improve their results. The shape and size of the breasts may experience significant changes over time secondary to pregnancy, weight fluctuations, and aging. A successful breast procedure in these patients may include not only adding much needed volume and shape stability offered with a breast implant but also tightening of the ptotic skin envelope and repositioning of the low nipple–areolar complex. The success of the augmentation mastopexy is multifactorial, but implementing the optimal surgical technique based on patient factors can significantly contribute to the long-term success of the procedure. Patient education and perioperative decision-making are critical to achieving success in these procedures. However, the ultimate decisions and approach must be executed skillfully to insure a successful outcome. The details, decisions, and experience-based pearls involved in this operation can provide the guidance to perform this operation with expert precision.

In this chapter, the focus is on reviewing in details of the surgical techniques utilized in shaping the breast through augmentation mastopexy. As the focus of this chapter is on the ability to “shape” the breast into the desired outcome, we will initially focus on the preoperative evaluation with the patient, including consideration of the patient’s anatomical findings, as well as the patient’s desired final aesthetic outcome. Based on this initial assessment with determination of the desired “shape,” the options for mastopexy approach, implant selection, and the preferred pocket for implant placement will be discussed. This chapter will then in greater detail review the preoperative markings, techniques employed for the creation of different breast pockets, details on placement of a variety of different implants, tailor-tacking technique, de-bulking of the lower pole, decision-making in the final shaping of the breast, and postoperative management. The impact of each of these steps on preservation of blood supply and the ultimate safety of the procedure is a focus of this chapter. The ability to “shape” the breast and perform a one-stage augmentation mastopexy procedure safely, reproducibly, and with results equal to or better than that achieved with a two-stage procedure leading to high patient and surgeon satisfaction is the goal of this chapter.