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Two-Stage Breast Augmentation-Mastopexy: How Many Return for the Mastopexy?

Nathan, Bassem F.R.C.S.; Mikhail, Mark; Nash, Zachary; Mascarenhas, Lawrence M.D.

Plastic and Reconstructive Surgery: February 2014 - Volume 133 - Issue 2 - p 233e–234e
doi: 10.1097/01.prs.0000434414.63088.56

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,

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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.

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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.

Riverside Hospital

London, United Kingdom

Mark Mikhail

Imperial College London

London, United Kingdom

Zachary Nash

Lawrence Mascarenhas, M.D.

Guy’s and St Thomas’s Hospital

London, United Kingdom

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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
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