SINGLE STAGE Augmentation Mastopexy: Securing the Implant and IMF Location with An Autologous Dermal Graft

Goals/Purpose:  Mastopexy with augmentation is not an uncommon procedure in breast surgery. This combined procedure has been reported to result high rate of recurrent ptosis by several recent studies (1-5). The goal of this study is to introduce a novel technique that addresses the importance of two variables- breast position and IMF location via autologous dermal graft, for an improved end results in augmentation mastopexy. 

Methods/Technique:  Twenty-one patients operated over a period of two years from August 2005 through August 2007 were included in the study. The augmentation was performed first followed by adjusting the skin envelope and breast parenchyma to contour around the new breast volume. Augmentation/mastopexy with autologous dermal graft interpositioning, presented in this paper, is a novel technique and the technique is described in detail.

Results/Complications:  There were no major vital complications like death, major flap or nipple necrosis. The most common complications seen were: inadequate circumvertical skin incision, inadequate transposition of nipple-areolar complex, overprojection of areola and minor complications such as suture abscess. All complications were revised under local anesthesia. No recurrent ptosis was seen in any of the patients ( Fig 1,2 ) . Mean follow-up was 39.2 months (range 36-48 months).

Conclusion:  Simultaneous augmentation mastopexy with autologous dermal graft interpositioning is a safe procedure. The dermal graft is easy to harvest. It is cost-effective. This technique ensures an improved breast appearance via securing the breast position and delineating the inframammary location. The very early results are promising but long term results needed to be evaluated.     

References:

1. Stevens WG, Freeman ME, Stoker DA, Quardt SM, Cohen R, Hirsch EM.

 One-stage mastopexy with breast augmentation: a review of 321 patients. Plast Reconstr Surg. 120(6):1674-9, 2007.

2. Spear SL, Boehmler JH 4th, Clemens MW. Augmentation/mastopexy: a 3-year review of a single surgeon's practice. Plast Reconstr Surg. 118(7 Suppl):136S-147S; discussion 148S-149S, 150S-151S, 2006.

3. Elliott LF. Circumareolar mastopexy with augmentation. Clin Plast Surg. 29(3):337-47, 2002.

4. Gonzalez-Ulloa, M. Correction of hypotrophy of the breast by means of exogenous material. Plast Reconstr Surg. Transplant Bull. 25; 15, 1960.

5. Hammond DC. Augmentation Mastopexy. General Considerations. In  Surgery of the Breast Principles and Art. 2nd Ed. Vol II. Spear SL (Ed.). Lippincott-Williams & Wilkins, Philadelphia, 2006, pp 1403-1416.

Figures:

Fig 1: The harvested dermis was interposed between pectoralis major caudal border and chest wall by using 2-0 PDS.

Fig 2: Pre and postoperative fourth year lateral view.