Superior pedicle autoaugmentation mastopexy: a review of 34 consecutive patients.

[BACKGROUND] The ptotic breast deformity results from two synergistic forces: involution of breast parenchyma leading to a loss of volume, along with a converse laxity of the skin envelope, which becomes inelastic and accommodating. As the breast tissue descends inferiorly on the chest wall with gravity, there is an apparent volume loss in the upper pole and the central breast, and the lower pole becomes fuller and often wider.

[OBJECTIVES] The authors propose a technique whereby the superior pedicle vertical mammaplasty technique originally described by Lassus is modified to include transposition of glandular tissue to restore central mound projection while simultaneously narrowing the lower breast base and raising the inframammary crease.

[METHOD] From 2003 to 2007, 34 patients underwent a superior pedicle autoaugmentation mammaplasty. Ages ranged from 22 to 47 years. The mean follow-up period was 24 months. Patients were selected preoperatively based on the presence of wide, low-lying breasts lacking central projection. In all cases, the patients expressed a desire to have a more youthful breast without the presence of an implant. The breast tissue usually retained in an inferior breast reduction was elevated on a superior dermal pedicle blood supply and transposed into a prepectoral pocket under the central breast. The medial and lateral pillars were then sutured together to narrow the breast base.

[RESULTS] All patients tolerated their procedure well. Two patients developed seromas that were percutaneously drained in the office. All 34 patients stated that they were very satisfied with the shape and size of their breasts postoperatively. No patient desired subsequent breast augmentation.

[CONCLUSIONS] Modifying the vertical-scar mastopexy originally described by Lassus and later refined by Lejour, Hall-Findlay, and de la Plaza et al, the authors have created a dermoglandular extension of the superior pedicle that can be transposed behind the nipple-areolar complex. This restores central mound projection while also narrowing the lower breast base and raising the inframammary crease. In carefully selected patients with low-lying, wide breasts who do not desire breast augmentation without a prosthetic, this technique can be employed to reliably recreate a more youthful breast shape.