A Systematic Review and Meta-Analysis of Single-Stage Augmentation-Mastopexy
Methods/Technique: The MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases were queried using the search terms “augmentation AND mastopexy.” Two levels of screening identified all studies including at least 25 patients which report outcomes following augmentation-mastopexy. The DerSimonian and Laird random-effects model was used to perform the meta-analysis of pooled complication rates. Q and I2statistics assess model heterogeneity. Funnel plots were used to assess publication bias.
Results/Complications: Among the 14 studies reporting total complications, the pooled total complication rate was 14.5% (95% confidence interval [CI] 9.0-19.9%). The most common individual complication was recurrent ptosis with a pooled incidence of 4.0% (95% CI 2.2-5.7%), followed by post-operative asymmetry (2.7%, 95% CI 1.0-4.4%). The pooled incidence of capsular contracture and poor scarring were 1.9% (95% CI 0.8-3%) and 1.8% (95% CI 1.0-2.6%), respectively. Infection, hematoma, and seroma were rare with pooled incidences of less than 1% each. The pooled reoperation rate obtained from 10 studies was 11.0% (95% CI 5.4-16.7%). Significant heterogeneity was noted for total complication and reoperations (Q statistic p<0.001, I2=89.3%; p<0.001, I2=91.1%, respectively).
Conclusion: This is the first study to systematically synthesize complication profiles and reoperation rates following augmentation-mastopexy. We reviewed 4,856 augmentation-mastopexies and found acceptable pooled complication rates. The pooled reoperation rate of 11% compares favorably with the requisite 100% reoperations with a staged procedure. It must be noted that all studies identified in this systematic review emphasized the importance of careful patient selection in achieving favorable outcomes; however, in the hands of a skilled surgeon, single-stage augmentation-mastopexy can be safe and effective.