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The Challenges of Augmentation Mastopexy in the Massive Weight Loss Patient: Technical Considerations

Coombs, Demetrius M. B.S.; Srivastava, Udayan M.D.; Amar, Dalit M.D.; Rubin, J. Peter M.D.; Gusenoff, Jeffrey A. M.D.

Plastic & Reconstructive Surgery: May 2017 - Volume 139 - Issue 5 - p 1090–1099
doi: 10.1097/PRS.0000000000003294
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Discussion

Background: Augmentation mastopexy in the massive weight loss population is challenging because of poor skin elasticity and lack of inframammary support. Despite several large studies of augmentation mastopexy in the literature, few data exist regarding this unique patient population. The authors examine early postoperative ptosis, implant malposition, and strategies to optimize outcomes.

Methods: A retrospective review of massive weight loss patients who underwent augmentation mastopexy from 2003 to 2011 was performed to record age, body mass index, implant characteristics, postoperative ptosis, and implant malposition.

Results: Thirty patients were identified with a mean age of 44.8 ± 8.5 years, mean current body mass index of 26.1 ± 3.9 kg/m2, and mean follow-up time of 283.5 days (range, 7 to 1095 days). Preoperatively, patients mostly presented with grade 3 ptosis (63.3 percent). Five patients (16.7 percent) developed postoperative ptosis within the first 3 months after surgery, with no increase after this time. Implant malposition increased significantly with time: 61.9 percent by 12 months (p = 0.006), with a median time for implant malposition of 160 days. Postoperative ptosis was significantly related to age (p = 0.039) and a larger left-side implant (p = 0.022). Implant malposition was significantly related to higher current body mass index (p = 0.047), but not to implant size. Two patients (6.6 percent) underwent revision procedures.

Conclusion: Massive weight loss patients have an increased risk of early postoperative ptosis or implant malposition, reinforcing the need for appropriate preoperative counseling to manage patient expectations.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Pittsburgh, Pa.

From the Department of Plastic Surgery, University of Pittsburgh Medical Center.

Received for publication August 16, 2016; accepted November 8, 2016.

Presented in part at the 59th Annual Meeting of the Robert H. Ivy Society of Plastic Surgeons, in Bethlehem, Pennsylvania, March 8 through 9, 2013; and the 55th Annual Meeting of the Ohio Valley Society of Plastic Surgeons, in Indianapolis, Indiana, May 17 through 19, 2013; and presented at the Aesthetic Meeting 2014, Annual Meeting of the American Society for Aesthetic Plastic Surgery, in San Francisco, California, April 26 through 28, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Jeffrey A. Gusenoff, M.D., Department of Plastic and Reconstructive Surgery, 3380 Boulevard of the Allies, Suite 180, Pittsburgh, Pa. 15213, gusenoffja@upmc.edu

©2017American Society of Plastic Surgeons