Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

The Tissue-Based Triad: A Process Approach to Augmentation Mastopexy

Lee, Michael R. M.D.; Unger, Jacob G. M.D.; Adams, William P. Jr. M.D.

Plastic and Reconstructive Surgery: August 2014 - Volume 134 - Issue 2 - p 215–225
doi: 10.1097/PRS.0000000000000387
Cosmetic: Original Articles

Background: Among the most exigent operations in plastic surgery is the combination of augmentation and mastopexy. The surgical challenge is related to oppositional forces that complicate the operative predictability. The purpose of this study was to investigate use of the tissue-based triad process approach in patients undergoing augmentation mastopexy. Measured components of the approach include skin stretch, nipple to inframammary fold distance on maximal stretch, and vertical excess.

Methods: Patients were selected for the study if they had been treated with one- or two-stage augmentation mastopexy, or mastopexy alone. Data gathered included preoperative measurements, operative details, complications, and outcomes including reoperation rate.

Results: A total of 176 consecutive patients were identified as meeting study inclusion criteria. Mean follow-up was 1.5 years. Seventy-one of 176 patients underwent mastopexy alone. Of the 176 patients included, 105 were treated with augmentation mastopexy. Ninety-one of 105 augmentation mastopexy operations were performed in one stage. The average amount of vertical excess was 5 cm. Nine patients exhibited delayed wound healing, while six (6.5 percent) required reoperations for scar revision (n = 1), delayed wound healing requiring revision (n = 2), hematoma (n = 1), seroma (n = 1), and soft-tissue stretch (n = 1). Fourteen of 105 patients were treated in two stages. Average vertical excess was 7.5 cm.

Conclusions: Use of the tissue-based triad process approach provided objectivity in determining which patients should undergo one- versus two-stage augmentation mastopexy. Use of this approach helps guide surgical decision making and is associated with lower reoperation rates.


Supplemental Digital Content is available in the text.

Dallas, Texas

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication June 11, 2013; accepted November 20, 2013.

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

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (

William P. Adams, Jr., M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 6901 Snider Plaza, Suite 120, Dallas, Texas 75204,

©2014American Society of Plastic Surgeons