Vertical Scar Mastopexy with Centrally-Based Auto-Augmentation Flap: A Canadian Single-Centre Experience

Goals/Purpose: Mastopexy is one of the most commonly performed procedures in aesthetic surgery. Numerous mastopexy techniques have been described, all of which aim to correct nipple malposition and glandular ptosis to achieve improved overall breast aesthetics. Many patients presenting for mastopexy also desire improved superior pole fullness, although not all patients are willing to accept the increased breast size and potential risks associated with implant-based breast augmentation-mastopexy. In these patients, we have used a centrally-based auto-augmentation flap from the inferior pole of the breast during vertical scar mastopexy to improve superior pole fullness. The purpose of this study was to review our experience using vertical scar mastopexy with auto-augmentation flap in patients undergoing primary mastopexy, and to assess the safety of this versatile technique.

Methods/Technique: A retrospective chart review was performed for all patients who underwent vertical scar mastopexy with auto-augmentation flap at a single aesthetic surgery practice in Canada. Patients who had undergone any prior breast surgery were excluded. Data regarding patient demographics, procedural details and perioperative complications was collected for review.

Results/Complications: 239 patients underwent primary vertical scar mastopexy with auto-augmentation flap between January 2011 and December 2021. Average patient age at the time of procedure was 39 years (range, 17 to 64 years) and average body mass index (BMI) was 25.2 kg/m² (range, 15.1 to 38.1 kg/m²). Average length of follow-up was 459 days (range, 14 to 3306 days). 137 patients (57.3%) underwent another procedure at the time of mastopexy. Twelve patients (5.0%) experienced a perioperative complication with the most common complications being delayed wound healing (2.1%) and infection (1.7%). Three patients (1.2%) developed hematomas, two (0.8%) of which required surgical evacuation. One patient (0.4%) undergoing a concomitant abdominoplasty developed a pulmonary embolism. An additional thirteen patients (5.4%) underwent scar revision under local anesthesia. One patient (0.4%) had a finding of ductal carcinoma in situ in their resection specimen and required further treatment. There were no cases of fat necrosis associated with use of the auto-augmentation flap, and no cases of seroma or infection of the breast that required operative intervention.

Conclusion: Our experience using vertical scar mastopexy with a centrally-based auto-augmentation flap has demonstrated that this is a reliable and reproducible technique for patients seeking improved superior pole fullness without the use of a breast implant. Complications are uncommon. The revision rate is low and most revisions can be performed under local anesthesia.