Abstract
Background
After breast surgery, the late upward rotation of the nipple–areola complex and the increased of the fullness at the lower pole of the breast have been defined as a Bottoming out. Although several studies have focused on the safety and complication rate of the one-stage augmentation/mastopexy, there is no clear recommendation how to prevent the late complication of “bottoming out”.
Methods
A retrospective review was conducted of 48 consecutive patients who underwent one-stage mastopexy/augmentation using the reductive approach. Data collected included the following: patient's characteristics implant information, operative technique and postoperative results. Complication and revision rates were assessed to determine the efficacy of the reductive mastopexy/augmentation.
Results
All patients (N = 48) were available for follow-up, an average 18 months postoperatively. Overall complication rate was 14.5%. No severe complications were recorded. The most common complication was wound separation (2), followed by capsular contracture (2), and bottoming out (1). Seven patients (14.5%) underwent some form of revision surgery following the one-stage procedure. The revision rate due to bottoming out was 2.2%.
Conclusions
When performing the one-stage augmentation/mastopexy procedure, using the reductive mastopexy approach does effectively reduce the internal tension from the lower pole of the breast and helps to prevent the occurrence of bottoming out.
Level of Evidence: Level IV, therapeutic study
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Whidden PG (1978) The tailor-tack mastopexy. Plast Reconstr Surg 62:347
Gonzalez-Ulloa M (1960) Correction of hypertrophy of the breast by exogenous material. Plast Reconstr Surg 25:15
Spear SL, Boehmler JH 4th, Clemens MW. Augmentation/mastopexy: a 3-year review of a single surgeon's practice. Plast Reconstr Surg Dec 2006; 118(7 Suppl): 136S-147S; discussion 148S-149S, 150S-151S
Reus WF, Mathes SJ (1987) Preservation of projection after reduction mammaplasty: long-term follow-up of the inferior pedicle technique. Plast Reconstr Surg 82:644
Hönig JF, Frey HP, Hasse FM, Hasselberg J (2009) Autoaugmentation Mastopexy with an Inferior-Based Pedicle. Aesthetic Plast Surg 33(3):302–307
De Bruijn HP, Johannes S (2008) Mastopexy with 3D preshaped mesh for long-term results: development of the internal bra system. Aesthetic Plast Surg 32(5):757–765, Epub 2008 May 21
Brown RH, Izaddoost S, Bullocks JM (2010) Preventing the “bottoming out” and “star-gazing” phenomena in inferior pedicle breast reduction with an acellular dermal matrix internal brassiere. Aesthetic Plast Surg 34(6):760–767, Epub 2010 Jul 3
Spear SL, Seruya M, Clemens MW, Teitelbaum S, Nahabedian MY (2011) Acellular dermal matrix for the treatment and prevention of implant-associated breast deformities. Plast Reconstr Surg 127(3):1047–1058
Kirwan L (2002) A classification and algorithm for treatment of breast ptosis. Aesthet Surg J 2:355–363
Lassus C (1996) A 30-year experience with vertical mammaplasty. Plast Reconstr Surg 97:373–380
Lejour M, Abboud M, Declety A, Kertesz P (1990) Reduction of mammaplasty scars: from a short inframammary scar to a vertical scar. Ann Chir Plast Esthet 35(5):369–379
Hall-Findlay EJ (2004) Vertical breast reduction: new trends in reduction and mastopexy. Semin Plast Surg 18(3):211–224
Mallucci P, Branford OA (2012) Concepts in aesthetic breast dimensions: analysis of the ideal breast. J Plast Reconstr Aesthet Surg 65(1):8–16, Epub 2011 Aug 24
Hoch J, Stahlenbrecher A (2006) Bottoming out in augmentation mammaplasty correction and prevention. Handchir Mikrochir Plast Chir 38(4):233–239
Moscona RA, Fodor L (2008) One-stage periareolar breast augmentation and mastopexy for tuberous breasts and mild to moderate hypoplastic and ptotic breasts. In: Eisenmann-Klein M, Neuhann-Lorenz C (eds) Innovations in plastic and aesthetic surgery. Springer, Berlin, pp 371–376
Spear SL, Low M, Ducic I (2003) Revision augmentation mastopexy: indications, operations, and outcomes. Ann Plast Surg 51(6):540–546
Quan M, Fadl A, Small K, Tepper O, Kumar N, Choi M, Karp N (2011) Defining pseudoptosis (bottoming out) 3 years after short-scar medial pedicle breast reduction. Aesthetic Plast Surg 35(3):357–364, Epub 2010 Nov 17
Flowers RS, Smith EM Jr (1998) “Flip-flap” mastopexy. Aesthetic Plast Surg 22(6):425–429
Regnault P, Daniel RK, Tirkanits B (1988) The minus-plus mastopexy. Clin Plast Surg 15:595–600
Rohrich RJ, Gosman AA, Brown SA, Reisch J (2006) Mastopexy preferences: a survey of board-certified plastic surgeons. Plast Reconstr Surg 118(7):1631–1638
Acknowledgments
The authors thank Mr. E. Latimer-Sayer and Dr. M. Shiffman for the careful reviewing of the manuscript and constructive comments.
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
(M4V 202379 kb)
Rights and permissions
About this article
Cite this article
Mounir, AR., Mahdi, S. & Clark, P. Does the reductive mastopexy with implant approach prevent the late bottoming out?. Eur J Plast Surg 36, 757–764 (2013). https://doi.org/10.1007/s00238-013-0881-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-013-0881-9