Breast Augmentation and Mastopexy: How to Select and Perform the Techniques Minimizing Complications
The female breast forms one of the most attractive esthetic areas of the female anatomy. A beautiful breast is synonymous with sensuality. For that reason, there are multiple and varied surgical procedures for improving it [1–6]. Because of the mammary gland's own characteristics and the current tendency toward thin and stylized figures, the combination of hypoplasia and mammary ptosis is common in a single patient. This combination of alterations in the mammary gland is secondary primarily to pregnancies or significant variations in weight. Growth of the mammary gland during pregnancy and lactation stretches the breast's supporting tissues. This stretching results in a certain degree of damage to them, which causes the glands to lose support following pregnancy . Adding to this factor, the weight loss that many patients experience, ptosis, and mammary hypoplasia are even greater. This alteration is also common in patients who, not being pregnant, have suffered significant changes in body weight. All of this causes the combination of ptosis and hypoplasia in a single patient to become more and more frequent.
In spite of it being a common combination of pathologies, the medical literature expounds very little on the subject, and scientific studies have only recently begun appearing more consistently [8, 9]. The relevant thing about the combination of these two procedures at the same surgical time is that opinions regarding the benefit or difficulty and incidence of complications are quite diverse. While some authors say that performing mas-topexy and augmentation is a procedure that gives very good results, and that the incidence of complications is low [10–12], other studies state that it is a high-risk procedure with a greater number of complications than if the two surgeries were performed separately [8, 9, 13–15]. The authors who report a greater incidence of complications even warn that in some cases these complications can be severe and deforming . Persoffreports that combining both procedures is difficult and entails many complications , while Spear emphasizes that it is a complicated procedure with unpredictable results [9, 15]. The author agrees with Spear  that the combination of mastopexy and mammary augmentation is not as simple a procedure as performing mammary augmentation or mastopexy separately. Placing the implant and performing the lif ing entails many factors that should be taken into account and that do not appear in the separate procedures. All these factors have been amply commented on by Spear himself in his studies on the topic [8, 9, 15]. Therefore, when performing both procedures, the care and precautions taken to avoid complications should be fully exercised, one of them being the proper choice of the surgical technique to be employed. The authors who report good results with augmentation and mastopexy state that one of the most important points is proper selection of the surgical technique [10–13, 15, 16]. Although it is true that managing mammary hyp-oplasia or mammary ptosis individually is simpler than handling them together , our experience has demonstrated to us that by following certain premises, the procedure is feasible to perform with reduced number of complications . The author recommend a methodology for selecting the best option from among the different surgical techniques for obtaining the best results and for maximum avoidance of complications.
KeywordsMammary Gland Inferior Pole Inferior Portion Suprasternal Notch Dual Plane
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