Trading a ptotic breast for a visibly scarred breast with a chance of recurrent ptosis is a poor choice.
Three surgical considerations
Achieving Projection Using glandular flaps to produce coning - Coning is easily produced; however, getting it to last is the biggest problem. Closure of inferior breast pillars is the most secure way to maintain this “compression” over time.
Flowers and Smith – superiorly based parenchymal flap folded onto itself and sutured to the pectoral fascia at the level of the second rib.
Benelli 1990 -
Pectoralis - Inferiorly based dermoglandular pedicle is passed under a 3cm loop of pectoralis muscle and suspended to the central fascia with tacking sutures (e.g., Graf-Biggs procedure).
controversial from an oncologic point of view whether the pectoralis fascia should be divided, as this will require a more aggressive approach in case of later breast cancer