Breast SurgeryMastopexy Techniques After Massive Weight Loss An Algorithmic Approach and Review of the LiteratureColwell, Amy S. MD*; Driscoll, Daniel MD*; Breuing, Karl H. MD†Author Information From the *Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and †Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Received June 13, 2008 and accepted for publication, after revision, July 18, 2008. Karl Breuing is on the speaker's bureau for LifeCell. Products Discussed: AlloDerm (LifeCell). Reprints: Amy S. Colwell, MD, Division of Plastic Surgery, Mass General Hospital, 15 Parkman Street Wang 435, Boston MA 02114. E-mail: [email protected]. Annals of Plastic Surgery: July 2009 - Volume 63 - Issue 1 - p 28-33 doi: 10.1097/SAP.0b013e318188b976 Buy Metrics Abstract Mastopexy after massive weight loss (MWL) poses unique challenges that may not be successfully addressed with traditional mastopexy procedures. Several novel techniques have been proposed to improve esthetic outcomes; however, little data exists to guide the plastic surgeon on choice of technique for individual patients. A literature review revealed 10 articles with specific emphasis on mastopexy techniques in MWL patients. These articles focused on ways to improve shape, projection, and long-term results, using autologous tissue alone or combined with breast implants. Key concepts include increasing volume of the breast by utilizing excess axillary tissue (lateral thoracic/spiral/intercostal artery perforator flap), modification of existing superomedial pedicle techniques to maximize breast volume, and increasing breast parenchymal support with suture fixation and dermal suspension. This article offers an algorithmic approach to treat breast ptosis in the MWL patient based on breast volume, axillary tissue, desired scar location, and preferred surgical technique. © 2009 Lippincott Williams & Wilkins, Inc.