Plastic & Reconstructive Surgery:
Nathan, Bassem F.R.C.S.; Mikhail, Mark; Nash, Zachary; Mascarenhas, Lawrence M.D.
Riverside Hospital, London, United Kingdom
Imperial College London, London, United Kingdom
Guy’s and St Thomas’s Hospital, London, United Kingdom
Correspondence to Dr. Nathan, Riverside Hospital, Great West Road, London TW8 9DR, United Kingdom, firstname.lastname@example.org
Combined breast augmentation/mastopexy remains one of the most controversial operations in the cosmetic surgeon’s armamentarium. Numerous studies have analyzed the outcome of one-stage breast augmentation combined with mastopexy. The present study analyzed how many patients with ptosis will return for mastopexy after a primary breast augmentation.
Patients with breast ptosis (nipple at or below the inframammary crease) were given the choice of single-stage breast augmentation combined with mastopexy or breast augmentation with the proviso that mastopexy might be required after 6 months. Patients were reassured that should they desire the mastopexy later, they would pay only a reduced fee. Thus, there was no difference in cost to the patient between a one-stage and a two-stage procedure. The lateral preoperative photographs of 4432 consecutive patients who underwent primary breast augmentation were studied.
A total of 376 patients were identified with the nipple at or below the inframammary crease. Seven of the 376 patients returned for mastopexy after the primary augmentation.
Numerous studies have documented significant risks associated with combined breast augmentation and mastopexy.1–3 Even studies that have advocated combined augmentation/mastopexy have also reported rather prohibitively high morbidity rates.4–6 This large study shows that the two-stage option may prove beneficial to many women seeking primarily volume increase.
Analysis of outcome in cosmetic surgery is based on the assumption that patients will return for secondary surgery rather than go elsewhere. With this in mind, adopting a policy of breast augmentation as an initial treatment strategy works well and is acceptable for most women with breast ptosis. Variations in patient demographic profiles and cultural diversity determine how postoperative ptosis is perceived or accepted by patients. In our practice, a two-stage breast augmentation/mastopexy policy has meant breast augmentation with no further surgery for most of our patients. In view of the increased morbidity rate of the combined procedure, we believe it is important not to deny women who are primarily seeking an increase in volume the option of augmentation alone, and we suggest offering delayed mastopexy at a reduced cost in order to reassure patients that they will not lose out financially. The high revision rate7 for one-stage breast augmentation/mastopexy may also offset the apparent cost savings of this procedure.
In conclusion, offering breast augmentation in women with ptosis may result in fewer mastopexies being performed and reduced morbidity rates while remaining aesthetically acceptable.
The authors have no financial interest to declare in relation to the content of this article and received no funding for this study.
Bassem Nathan, F.R.C.S.
London, United Kingdom
Imperial College London
London, United Kingdom
Lawrence Mascarenhas, M.D.
Guy’s and St Thomas’s Hospital
London, United Kingdom
1. Eagan SL, Atashroo DA, Puckett CL, Henry SL. Concurrent Podium Paper Sessions: Scientific Session 5C: Clinical Research Outcomes 68C: Combined augmentation mastopexy. Plast Reconstr Surg. 2010;125:50
2. Codner MA, Mejia JD, Locke MB, et al. A 15-year experience with primary breast augmentation. Plast Reconstr Surg. 2011;127:1300–1310
3. Spear SL, Boehmler JH, Clemens MW. Cosmetic augmentation/mastopexy: A 3-year review of a single surgeon’s practice. Plast Reconstr Surg. 2006;118:136S–147S
4. Scheer J, Patel A, Blount A, et al. One-stage augmentation and mastopexy: A review of outcomes in a large patient population. Plast Reconstr Surg. 2012;130(Suppl 5S-1):85–86
5. Seify H, Ismail K, Evans G. Primary augmentation/mastopexy using large implants: Is it a safe technique? A 4-year single surgeon review. Plast Reconstr Surg. 2010;126:67
6. Stevens WG, Freeman ME, Stoker DA, et al. One-stage mastopexy with breast augmentation: A review of 321 patients. Plast Reconstr Surg. 2007;120:1674–1679
7. Adams WP. Discussion: Simultaneous augmentation mastopexy: A retrospective 5-year review of 332 consecutive cases. Plast Reconstr Surg. 2013;131:157–158
Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:
* Text—maximum of 500 words (not including references)
* References—maximum of five
* Authors—no more than five
* Figures/Tables—no more than two figures and/or one table
Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/. We strongly encourage authors to submit figures in color.
We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.