Abstract
Background
Current mastopexy techniques have evolved to decrease scar length and maintain a more consistent upper pole fullness, improving the breast shape. Many different approaches have tried to suspend breast tissues to achieve a more attractive upper pole. Most of the auto-augmentation mastopexy techniques use inferior-based breast parenchymal tissues to fill the upper part.
Methods
This paper presents a modified approach to fill the breast's upper pole, with an inferolateral-based breast flap. The advantages of changing the inferior-based auto-augmentation technique to the inferolateral comprise improving blood supply and increasing repositioned breast flap's mobility. In our technique, the breast tissue used to auto-augment the upper pole receives its blood supply from pectoral perforators and lateral breast tissue. When surgeons need more flap mobility, they can raise the medial edge of this flap from the pectoral fascia to mobilize this flap higher on the chest wall, depending on the lateral blood supply. One other advantage is that when the inferolateral-based breast tissue is pulled in a superomedial direction to fill the upper part, the lateral ptotic breast tissues come closer to the breast meridian to meet with medial breast parenchyma easily. The tension on the vertical parenchymal suture line is reduced with this approach.
Conclusion
Our technique can be used in most mastopexy operations and for all types of ptosis except for cases with insufficient breast volume. It brings safety to the auto-augmentation procedure and is also time-saving. The stability of breast shape and upper pole fullness lasts as long as other auto-augmentation procedures; therefore, it can be an excellent alternative to other techniques.
Level of evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Biggs TM, Graf R, Taneja A (2003) Maintaining shape in mastopexy. Aesthet Surg J 23(5):391–392
Kirwan L, Wazir U, Mokbel K (2015) Breast auto-augmentation: a versatile method of breast rehabilitation—a retrospective series of 107 procedures. Arch Plast Surg 42(4):438–455.
Gümüş N (2013) A versatile modification of dermoglandular hammock flap for mastopexy: extended hammock. J Plast Surg Hand Surg 47(4):252–257.
Elizabeth J Hall-Findlay (2004) Vertical breast reduction. Semin Plast Surg 18(3): 211–224.
Gurunluoglu R, Sacak B, Arton J (2013) Outcome analysis of patients undergoing autoaugmentation after breast implant removal. J Plast Reconstr Surg 132(2):304-315.
Hönig JF et al (2009) Autoaugmentation mastopexy with an inferior-based pedicle. Aesthetic Plast Surg 33(3):302–307
Graf R, Biggs TM, Steely RL (2000) Breast shape: a technique for better upper pole fullness. Aesthetic Plast Surg 24(5):348–352
Stefano Bonomi, André Salval, Fernanda Settembrini, Chiara Gregorelli, Gaetano Musumarra, Vincenzo Rapisarda (2012) Inferiorly based parenchymal flap mmmaplasty: a safe, reliable, and versatile technique for breast reduction and mastopexy. Plast Reconstr Surg 130(1):116e–125e.
Noemi Kelemen, Ruben Y Kannan, Graham J Offer (2013) A stacked technique of mastopexy: volume redistribution mastopexy with inferior flap and superomedially based pedicle. Aesthetic Plast Surg 37(2):349–353.
Regnault P (1976) Breast ptosis. Definition and treatment. Clin Plast Surg 3(2):193–203.
Nahai Foad (2005) Superior pedicle vertical scar mammaplasty: surgical technique. In: Hamdi Moustapha, Hammond Dennis C (eds) Vertical scar mammaplasty. Springer, New York, pp 25–35
Swanson E (2015) Ideal breast shape: women prefer convexity and upper pole fullness. Plast Reconstr Surg 135(3):641e–643e
Lassus C (1999) Update on vertical mammaplasty. Plast Reconstr Surg 104(7):2289–2298
Lejour M (1999) Vertical mammaplasty: update and appraisal of late results. Plast Reconstr Surg 104(3):771–781
Poëll JG (2004) Vertical reduction mammaplasty. Aesthetic Plast Surg 28(2):59–69
Corinne E Wee, Joseph Younisi et al (2020) Understanding breast implant illness, before and after explantation, a patient reported outcomes study. Ann Plastic Surg 85(Supplement 1):82–86.
Mark Lee, Ganesa Ponraja, Kevin McLeod, Smathi Chong (2020) Breast implant illness: a biofilm hypothesis. Plast Reconstr Surg Glob Open 8(4): e2755
Woo Jin Song, Sang Gue Kang, Bommie Florence Seo, Nam-Kyong Choi, Jung Ho Lee (2020) A systematic review of the National Breast Implant Registry for Application in Korea: Can We Predict "Unpredictable" Complications?. Medicina 56(8):370.
Mark Gorney, Patrick G Maxwell, Scott L Spear (2005) Augmentation mastopexy. Aesthet Surg J 25(3):275–284.
Watfa W, Zaugg P, Baudoin J, Bramhall RJ, Raffoul W, di Summa PG (2019) Dermal triangular flaps to prevent pseudoptosis in mastopexy surgery: the Hammock technique. Plast Reconstr Surg Glob Open 7(11):e2473.
Abramo AC, Lucena TW, Sgarbi RG, Scartozzoni M (2019) Mastopexy autoaugmentation by using vertical and triangular flaps of mammary parenchyma through a vertical ice cream cone-shaped approach. Aesthetic Plast Surg 43(3):584–590
Liacyr Ribeiro, Affonso Accorsi Jr, Afonso Buss, Marcelo Marcal-Pessoa (2002) Creation and evolution of 30 years of the inferior pedicle in reduction mammaplasties. Plast Reconstr Surg 110(3):960–970.
Lisanne Grünherz, Anna Burger, Pietro Giovanoli, Nicole Lindenblatt (2019) Long-term results measured by BREAST-Q reveal higher patient satisfaction after "Autoimplant-Mastopexy" than augmentation—Mastopexy. Gland Surg 8(5):516–526.
Elizabeth J Hall-Findlay (2002) Pedicles in vertical breast reduction and mastopexy. Clin Plastic Surg 29(3):379–391.
Graf R, Araujo L, Rippel R, Neto L, Pace D, Biggs T (2003) Reduction mammaplasty and mastopexy using the vertical scar and thoracic wall flap technique. Aesthetic Plast Surg 27(1):6–12
Kirwan L (2007) Breast autoaugmentation. Can J Plastic Surg 15(2):73–76
Ors S (2016) Autoaugmentation mastopexy modification prevents bottoming-out deformity and areola distortion: a preliminary report. Aesthetic Plastic Surg 40(4):497–506.
Acknowledgement
The author especially wants to thank Assoc. Prof. Dr. Çiğdem Ünal Gülmeden and Medical Student Oyku Atesci for their contribution to this manuscript's preparation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
Human or animal partcipants
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
For this type of study, informed consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Yilmaz, K.B. A Modified Superior Pedicle Mastopexy Technique With an Inferolateral-Based Auto Augmentation Flap. Aesth Plast Surg 45, 884–892 (2021). https://doi.org/10.1007/s00266-021-02127-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-021-02127-4