Parenchymal Transposition Flaps of lower pole breast tissue to the upper pole to attain fullness above.
IMF is formed by attachment of the dermis to the underlying fascia. To re-position the crease, these attachments need to be divided and re-created with sutures.
Skin Patients with inelastic, striated skin receive minimal lasting support from skin tightening. The skin below the NAC bears the brunt of the force and heals slowly, especially if the patient is a smoker.
Lateral folds will become more prominent post-op and therefore must be dealt with as part of the plan.
1. Haematoma: Uncommon. If large - return to theatre.
2. Infection: Uncommon - associated with poor vascularity - smokers etc.
3. NAC Necrosis: Uncommon - only occasionally seen in heavy smokers.
1. Asymmetry: May need revision.
2. Recurrent Ptosis The most common problem following mastopexy. Often associated with weight loss. A loss of 5kg will significantly be reflected in breast shape. It is said to occur most predictably with “skin only” mastopexy where the lower pole ptotic breast tissue is not excised at the initial procedure.
3. Upper pole flattening: Should be noted in pre-op assessment. Treated with appropriate sized implants.
Mastopexy is a temporary procedure - one should expect some recurrence with time.
Patient satisfaction is directly related to pre-operative decisions - the more time spent discussing the options with the patient pre-operatively, the less likely the need to justify the result.
1. Mastopexy is not a single operation but rather one that must be individualised to fit the patient’s deformity and desires. It bridges the spectrum of aesthetic breast surgery from augmentation to glandular reduction.
2. None of the currently accepted techniques are without problems. None of the solutions are permanent and there is always a trade off to be made - scars +/- implants.
3. As with any aesthetic procedure, careful pre-operative assessment - both physical examination and discussion of aesthetic goals with patient, will minimise the problems post operatively.
4. For the minor ptosis - augmentation +/- NAC elevation appears to give the most satisfactory results.
5. For more severe ptosis, lower pole resection and augmentation to achieve upper pole fullness offer the best and most predictable long term results.
Essentially aesthetic in nature so consideration of scarring is critical
Classification of Ptosis —Regnault
I nipple descends to level of inframammary fold
II nipple below fold but above lowest contour of breast