Mastopexy introduction



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SURGICAL PRINCIPLES

  1. reliable nipple-areolar transposition

  2. maximal parenchymal support

  3. minimal scars

Trading a ptotic breast for a visibly scarred breast with a chance of recurrent ptosis is a poor choice.
Three surgical considerations

  1. Projection

  2. Suspension

  3. Skin excision


Achieving Projection

  1. 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 -

  1. Parenchymal stacking

    • 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).

      1. 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

      2. may lead to breast movement with pectoralis contraction

  1. Mastopexy plus implant.


Glandular Suspension

  1. dermal suspension

  2. dermal cloak

    • 2cm wide dermal flap pediced on NAC and sutured to pectoralis fascia

  3. glandular suspension

    • sutures to pectoralis fascia

    • mesh (Goes)

  4. bipedicled pectoralis sling (Graff-Biggs)

  5. fascial sling
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