The Myth of Breast Autoaugmentation

Abstract

Over 100 publications claim to increase upper pole fullness or breast projection without a breast implant. However, there is no objective evidence that these efforts are effective. A recurring concept is “autoaugmentation,” a technique of repositioning a glandular pedicle in an attempt to restore fullness to the upper pole of the breast. In one technique, a parenchymal flap is tunneled through a loop of pectoralis muscle. The authors claim that this method simulates the effect of a 100–200 cc implant. However, comparison of standardized photographs reveals no benefit in upper pole projection or breast projection. Measurements show that techniques using fascial sutures to suspend the breast are also ineffective. Claims of greater breast projection and avoidance of postoperative ptosis using implantable mesh, sometimes called an internal bra, are not supported by measurements on matched photographs. Today this old concept is being repopularized by plastic surgeons with financial ties to the mesh manufacturer.

Despite long-standing recognition of its importance, photographic standardization is ignored. Typically, the after photographs are magnified or tilted in such a way as to suggest a treatment benefit that does not exist.

Negative measurement findings should not come as a surprise. No manipulation of breast tissue can create a net gain in breast volume. Only a vertical mammaplasty can reliably increase breast projection and upper pole projection, and then only modestly (1 cm), by trading width for projection. A Wise pattern does the opposite. A breast implant is needed to substantially boost upper pole projection. Implants can be inserted safely at the time of a mastopexy if a vertical method is used. Implants hold their shape more reliably than natural breast tissue. There is no need to resort to ineffective breast autoaugmentation.