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Page 2 of 14 Khan. Plast Aesthet Res 2018;5:45 I http://dx.doi.org/10.20517/2347-9264.2018.58

Keywords: Mastopexy, augmentation mammoplasty, augmentation with mastopexy, muscle split technique, one-stage
mastyopexy with augmentation

INTRODUCTION
Historically breasts are considered a sign of femininity, fertility and beauty. From the time of puberty, attain-
ment of body silhouette with feminine curve is considered an accomplished milestone. A lack of or loss of
such proportions may potentially affect the self esteem in some individuals whether the condition is primary
or secondary, following pregnancies, breast feeding, ageing or loss of weight. Augmentation and mastopexy
is one commonly performed procedure to restore the body silhouette, feminine curves and attractive body
proportions. The procedure can be performed in stages as mastopexy first to be followed by implant place-
ment later or one stage mastopexy with augmentation. One-stage or simultaneous mastopexy with augmen-
tation has an advantage of being cost-effective along with single hospitalisation and single recovery. Even
[2]
[1]
though the procedure was first performed by Gonzalez-Ulloa and Regnault , one still has to go through
a challenging learning curve before starts achieving consistently predictable results. The results of one-stage
augmentation mastopexy are frequently compared with mastopexy or breast augmentation when performed
[3-8]
alone . Outcome of these studies have concluded that in suitably selected patients, one-stage augmenta-
tion mastopexy procedure is relatively safe. However the analysis was primarily carried out to compare the
complications of each constituent components without considering the influence of the technique used for
implant placement or markings selection for breast or skin excision and their impact on the physiological,
anatomical or aesthetic outcome.

Implant pocket for mammoplasty and skin tightening for mastopexy are two distinctively separate pro-
cedures regardless of the stages selected, each influencing the other as well as having an impact on overall
[9]
results . Various implant pockets, from initial subglandular pocket to the most recent Muscle Split Biplane
technique, highlight the importance and advantages attached to each [10-14] . Scar selection for mastopexy can
be a surgeon’s choice. However, it is not without its impact on the outcome leading to revision surgeries [5,15,16] .
There is a lack of information where a technique has been defined for the preservation of the function of
breast, the safety of the procedure along with the restoration of normal breast morphometry leading to a
predictable aesthetic outcome. The following is the author’s experience of having performed 50 one-stage
augmentation mammoplasties in two years.

METHODS
A retrospective analysis of 50 cases of consecutive layered mastopexy with augmentation mammoplasties,
over a 2-year period, was carried out. All patients had Regnault Grade II or III ptosis where Grade II ptosis
is when nipple areolar complex (NAC) 2-3 cm below infra mammary crease (IMC) and grade III ptosis is
when NAC is > 3 cm below IMC. All implants were placed in muscle splitting pocket first and access for the
pocket was closed prior to the commencement of mastopexy. Incisions for mastopexy were selected on the
basis of pre-existing NAC to IMC. In all cases, mastopexy is performed using a medially based pedicle, leav-
ing a good layer of breast parenchymal tissue covering the implant, below and above the pedicle and where
skin excision is performed. Patients were divided into three groups on the basis of existing NAC to IMC
measurements.

Group “A” comprised patients who had periareolar mastopexy, Group “B” had patients with vertical single
scar markings and Group “C” comprised patients who had their mastopexy carried out using Wise pattern
markings.

All patients provided written informed consents. The study was performed with guiding principles set forth
in the Declaration of Helsinki.