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Case 3 two sides [Table 1]. Selection of markings for skin reduction
is paramount to achieve an aesthetically pleasing natural
A 20-year-old young adult female was seen for a severe breast with normal breast morphometry, comparable to the
developmental ptosis along with a very noticeable breast results seen following augmentation mammoplasty with an
[13]
size asymmetry. Patient has no history of childbirth or loss of implant alone. In authors’ opinion, use of periareolar or
weight or breast volume loss since puberty. She was wearing vertical scar markings in patients presenting with excess
a 34 E brassiere and her sternal notch to NAC distance was IMC to NAC measurements are likely to end with bottoming
measured 28 cm on her right and 26 cm on her left side out following simultaneous mastopexy with augmentation.
with a breast width of 14 cm on both sides. Her NAC to IMC Regardless of the degree of ptosis, type of skin markings
distance was measured 13 cm on her right and 10 cm on her for nipple elevation and mastopexy should ideally be based
left side respectively with a bilateral Class C ptosis [Figure on the preoperative NAC to IMC measurements. When
[13]
3a-c]. Patient was not interested in going any bigger than mastopexy is performed with vertical scar or wise pattern,
her current size. Mentor 225 mL Siltex cohesive II moderate the use of larger implant size selection may be restricted. Use
profile implants were chosen to be placed in muscle splitting of larger implant placements with these markings, is likely
biplane pocket to replace the anticipated breast tissue to result in complication namely skin and wound breakdown
reduction. Medially based flap with wise pattern markings mainly due to pressure exerted by implant on reduced skin
were used to reduce preoperative inframammary mammary envelope. In current series, mean size of the implants used
crease distance, NAC repositioning and envelope and breast in the series is 308 mL but when looked into the mean size of
reduction. New NAC was marked at 20 cm using IMC as a the implants used in three types of mastopexies, the results
reference, 273 g of tissue was removed from right and 247 were interesting. Mean size of the implants was considerably
g tissue was excised from her left breast. Her ten month cup and significantly larger in periareolar mastopexies than the
size was 34 DD with sternal notch to NAC distance of 20 cm, mean size of the implants used in vertical and wise pattern
NAC to IMC distance of 9.5 cm bilaterally with good size mastopexies [Table 2].
symmetry [Figure 3d-f].
A high complication rate has been reported when the
DISCUSSION procedure is combined together as simultaneous mastopexy
with augmentation. The author has reported a revision
[14]
Selection of implant pocket, markings for breast envelope rate of 9% in an earlier report on mastopexy in muscle
[7]
reduction and orientation of flap in simultaneous splitting biplane. The current series with long-term results
augmentation mastopexy are independent to each other and have shown a revision rate of 11.1%, up by nearly 2% when
can be selected in any combination.The use of combination compared with author’s earlier series. The most common

may affect the outcome with a variable rate of revision reason for revision being the excision of redundant skin in
surgery. Despite the various safety issues encountered 2 patients (16.7%) and vertical scar touch up in 2 patients
[7]
in the recent past, cohesive gel silicone breast implant (16.7%) [Table 3]. The revision rate of 11.1% after 10 years
[12]
remains the first choice for the volume replacement. In follow-up is acceptable and comparable with the published
majority of the patients presenting with hypoplasia, requests revision rate of 16.7% in simultaneous mastopexy with
for volume restoration in early type A ptosis, intended results augmentation and lower than 20% revision rate within five
are successfully achieved using breast implants with well- years following augmentation mammoplasty alone using
concealed scars. However more advanced ptosis necessitates saline-filled implants. [10]
the NAC repositioning with some sort of skin reduction. The Table 2: Implants sizes used in three different types of
NAC repositioning can be achieved using periareolar, vertical
scar or wise pattern markings depending on the skin excess mastopexies
and degree of ptosis. In current series 66.7% of the patients Procedure Implant Size
presented with varying degree of class A to C ptosis and 17.6% n Range (mL) Mean ± SD (mL)
of patients presented with varying combination of ptosis on Periareolar 54 170-555 327 ± 73.7
Vertical scar 45 200-525 277 ± 62.7
Table 1: Causes for mastopexy with augmentation in 108 Wise pattern 9 230-300 252 ± 29.9
patients SD: standard deviation
Cause for mastopexy n (%)
Table 3: Reasons for revision surgery performed in
Class A ptosis 6 (5.6)
mastopexy with augmentation
Class B ptosis 22 (20.4) Reason for revision n (%)
Class C ptosis 35 (32.4) Dog ear bilateral 2 (16.7)
Combination of A and C ptosis 2 (1.9) Dog ear unilateral 2 (16.7)
Combination of A and B ptosis 3 (2.8) Areolar scar revision 2 (16.7)
Combination of B and C ptosis 14 (13） Periareolar to vertical scar conversion 2 (16.7)
Pseudoptosis 9 (8.3) Nipple level asymmetry 1 (8.3)
Loose skin 2 (1.9) Capsular contracture 1 (8.3)
Tuberous breasts 2 (1.9) Vertical scar revision 1 (8.3)
Others 12 (11.2) Bottoming out 1 (8.3)
24 Plast Aesthet Res || Vol 3 || Issue 1 || Jan 15, 2016