Breast Augmentation and Mastopexy: How to Select and Perform the Techniques Minimizing Complications

  • Lázaro Cárdenas-Camarena

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 [7]. 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 [15]. Persoffreports that combining both procedures is difficult and entails many complications [14], while Spear emphasizes that it is a complicated procedure with unpredictable results [9, 15]. The author agrees with Spear [15] 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 [15], our experience has demonstrated to us that by following certain premises, the procedure is feasible to perform with reduced number of complications [17]. 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.


Mammary Gland Inferior Pole Inferior Portion Suprasternal Notch Dual Plane 
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  1. 1.
    Baroudi R, Lewis JR: The augmentation-reduction mam-maplasty. Clin Plast Surg 1976;3(2):301–308PubMedGoogle Scholar
  2. 2.
    McKissock PK: Reduction mammaplasty with a vertical dermal flap. Plast Reconstr Surg 1972;49(3):245–252CrossRefPubMedGoogle Scholar
  3. 3.
    Pitanguy I: Mammaplasty. Study of 245 consecutive cases and presentation of a personal technique. Rev Bras Cir 1961;42:201–220PubMedGoogle Scholar
  4. 4.
    Pitanguy I: A new technique of plastic surgery of the breast. Study of 245 consecutive cases and presentation of a personal technique. Ann Chir Plast 1962;7:199–208PubMedGoogle Scholar
  5. 5.
    Pontes R: Reduction mammaplasty – variations I and II. Ann Plast Surg 1981;6(6):437–447CrossRefPubMedGoogle Scholar
  6. 6.
    Rohrich RJ, Gosman AA, Brown SA, Tonadapu P, Foster B: Current preferences for breast reduction techniques: a survey of board-certified plastic surgeons 2002. Plast Reconstr Surg 2004;114(4):1724–1733CrossRefPubMedGoogle Scholar
  7. 7.
    Goldwyn RM: Plastic and Reconstructive Surgery of the Breast. Little, Brown and Company, Boston 1979Google Scholar
  8. 8.
    Spear SL, Pelletiere C V, Menon N: One-stage augmentation combined with mastopexy: aesthetic results and patient satisfaction. Aesthetic Plast Surg 2004;28(5):259–267CrossRefPubMedGoogle Scholar
  9. 9.
    Spear SL, Low M, Ducic I: Revision augmentation mas-topexy: indications, operations, and outcomes. Ann Plast Surg 2003;51(6):540–546CrossRefPubMedGoogle Scholar
  10. 10.
    de la Fuente A, Martin del Yerro JL: Periareolar mastopexy with mammary implants. Aesthetic Plast Surg 1992;16(4): 337–341CrossRefPubMedGoogle Scholar
  11. 11.
    Elliott LF: Circumareolar mastopexy with augmentation. Clin Plast Surg 2002;29(3):337–347CrossRefPubMedGoogle Scholar
  12. 12.
    12. Karnes J, Morrison W, Salisbury M, Schaeferle M, Beckham P, Ersek RA: Simultaneous breast augmentation and lif. Aesthetic Plast Surg 2000;24(2):148–154CrossRefPubMedGoogle Scholar
  13. 13.
    Baran CN, Peker F, Ortak T, Sensoz O, Baran NK: Unsatisfactory results of periareolar mastopexy with or without augmentation and reduction mammoplasty: enlarged areola with flattened nipple. Aesthetic Plast Surg 2001;25(4):286–289CrossRefPubMedGoogle Scholar
  14. 14.
    PersoffMM: Vertical mastopexy with expansion augmentation. Aesthetic Plast Surg 2003;27(1):13–19CrossRefPubMedGoogle Scholar
  15. 15.
    Spear SL: Augmentation/mastopexy: “surgeon, beware”. Plast Reconstr Surg 2003;112(3):905–906CrossRefPubMedGoogle Scholar
  16. 16.
    Puckett CL, Meyer VH, Reinisch JF: Crescent mastopexy and augmentation. Plast Reconstr Surg 1985;75(4):533–543CrossRefPubMedGoogle Scholar
  17. 17.
    Cardenas-Camarena L, Ramírez-Macias R: Augmentation/mastopexy: how to select and perform the proper technique. Aesthetic Plast Surg 2006;30(1):21–33CrossRefPubMedGoogle Scholar
  18. 18.
    Tebbetts JB: Dual plane breast augmentation: optimizing implant-sof -tissue relationships in a wide range of breast types. Plast Reconstr Surg 2001;107(5):1255–1272CrossRefPubMedGoogle Scholar
  19. 19.
    Benelli L: A new periareolar mammaplasty: the “round block” technique. Aesthetic Plast Surg 1990;14(2):93–100CrossRefPubMedGoogle Scholar
  20. 20.
    Planas J, Cervelli V, Planas G: Five-year experience on ultrasonic treatment of breast contractures. Aesthetic Plast Surg 2001;25(2):89–93CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Lázaro Cárdenas-Camarena
    • 1
  1. 1.Unit of Plastic Surgery GuadalajaraUniversity Guadalajara MexicoGuadalajaraMéxico

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