Demystifying trans-axillary augmentation/periareolar mastopexy: a novel, two-stage, single-operation approach to management of the contralateral breast in implant reconstruction.

[BACKGROUND] Following unilateral tissue expander/implant reconstruction, combined augmentation/mastopexy of the contralateral breast may be performed in an attempt to improve breast symmetry. Combined augmentation/mastopexy can be a very difficult operation, even for the surgeon with substantial experience. To simplify the technical approach to this complex problem, the senior author (PGC) has developed a 'two-stage, single-operation' approach. The purpose of this study is to review the safety and efficacy of this approach to the contralateral breast in the setting of unilateral, implant-based reconstruction.

[METHODS] A retrospective review of all combined trans-axillary augmentation/periareolar mastopexies performed from 1998 to 2007 was undertaken. Only patients who had a history of prior unilateral mastectomy and immediate expander placement were included. Photographic documentation of long-term aesthetic results was evaluated by two independent observers.

[RESULTS] In total, 26 combined, trans-axillary augmentation/periareolar mastopexies were performed in patients, who had initiated unilateral, postmastectomy, tissue expander/implant reconstruction on the contralateral side. No patient desired revisional surgery for inadequate ptosis correction or malpositioning of the nipple. A total of 69% of patients had a 'very good to excellent' overall aesthetic result. Of those patients who were deemed to have a 'good' aesthetic result, the development of a capsular contracture in the reconstructed breast detracted from the overall aesthetics.

[CONCLUSION] The two-stage, single-operation approach to unilateral augmentation/mastopexy described here can produce a good aesthetic result and allow for adequate oncologic follow-up. In particular, excellent results are seen in patients with grade I or II ptosis and good-quality skin preoperatively. Monitoring of the breast for cancer, using mammography, is still possible with this technique.