Secondary Logo

Share this article on:

Vertical Augmentation/Mastopexy: “Surgeon, Embrace”

Swanson, Eric M.D.

Plastic and Reconstructive Surgery: June 2015 - Volume 135 - Issue 6 - p 1063e–1064e
doi: 10.1097/PRS.0000000000001245

Swanson Center, 11413 Ash Street, Leawood, Kan. 66211,

Back to Top | Article Outline


Khavanin et al.1 reiterate the conventional view2 that a mastopexy and breast implant work at cross purposes: the mastopexy tightens the skin envelope and the breast implant expands it. Spear et al.3 opined that the risk of combined surgery was not only additive but exponential, cautioning, “surgeon, beware.”2

Nonvertical mammaplasties have important anatomical limitations.4–6 A breast implant is expected to stretch the lower pole and apply pressure on an inferior pedicle, which remains tethered at the inframammary fold, risking nipple ischemia.4 A periareolar mastopexy, paradoxically, removes tissue from the area to be stretched by the implant, not from the lower pole, where it is excessive; areola deformities and persistent ptosis are frequent problems.4,6

The design of a vertical mastopexy with a medial pedicle is much different (Fig. 1).4 The short pedicle is based superficially, where it is less susceptible to pressure because the base of the pedicle moves up with the breast mound.4,7 Eighty percent of nipple elevation derives from breast mound elevation and only 20 percent comes from nipple repositioning.7 There is less risk to nipple perfusion, even when using implant volumes in the range of 200 to 575 cc.4 Measurement data consistently favor a vertical mammaplasty.5,6 After a Wise-pattern mammaplasty, women often resemble candidates for a vertical augmentation/mastopexy (Fig. 1).4

Fig. 1

Fig. 1

The authors1 recognize that the mastopexy technique varied between (mostly retrospective) studies and even within studies. By contrast, my prospective patient-reported outcome study8 (n = 47) and clinical study4 (n = 146) featured only vertical augmentation/mastopexies and included cohorts of vertical mastopexy–only patients for comparison. Khavanin et al.1 evidently confused these studies, entering the limited clinical data obtained from patient surveys8 in their tables and erroneously referencing the clinical study.4 Unfortunately, the data from the larger clinical study4 were not included.

A systematic review is no more reliable than its constituent studies.1 Meta-analyses, regarded as Level I evidence, typically include only randomized trials or high-level observational studies. Complication and reoperation rates are heavily influenced by the surgeon’s definition of a complication4 and willingness to perform a revision.4,9 Major breast asymmetry is difficult to treat by mastopexy alone; it is much easier to match augmented breasts.4 Patients with very ptotic breasts are excellent candidates for augmentation/mastopexy because they typically require upper pole volume restoration. Implant volume is not a risk factor.4 Inadequate lower pole resection is usually to blame for persistent ptosis.4

Patient satisfaction after a vertical augmentation/mastopexy is 91.5 percent.8 This finding is important because it is commonly believed that augmentation/mastopexy patients are difficult and harbor unrealistic expectations.10 Vertical augmentation/mastopexy is neither inherently dangerous nor technically difficult.4 On the contrary, this combination offers at least 16 positive synergies that reduce difficulty and improve the aesthetic outcome.4 Any woman who is a candidate for augmentation and mastopexy performed individually is a candidate for the combined procedure.4 Staging is unnecessary.4 Vertical augmentation/mastopexy patients are no more discriminating than other cosmetic breast surgery patients and report similarly high levels of patient satisfaction.8 The new mantra? Augmentation/mastopexy: surgeon, embrace.

Back to Top | Article Outline


The author has no financial interest to declare in relation to the content of this communication. There was no outside funding for this study.

Eric Swanson, M.D.

Swanson Center

11413 Ash Street

Leawood, Kan. 66211

Back to Top | Article Outline


1. Khavanin N, Jordan SW, Rambachan A, Kim JY.. A systematic review of single-stage augmentation-mastopexy. Plast Reconstr Surg. 2014;134:922–931
2. Spear S.. Augmentation/mastopexy: “Surgeon, beware”. Plast Reconstr Surg. 2003;112:905–906
3. Spear SL, Dayan JH, Clemens MW.. Augmentation mastopexy. Clin Plast Surg. 2009;36:105–115
4. Swanson E.. Prospective comparative clinical evaluation of 784 consecutive cases of breast augmentation and vertical mammaplasty, performed individually and in combination. Plast Reconstr Surg. 2013;132:30e–45e; discussion 46e–47e
5. Swanson E.. Comparison of vertical and inverted-T mammaplasties using photographic measurements. Plast Reconstr Surg Glob Open. 2013;1:e89
6. Swanson E.. A retrospective photometric study of 82 published reports of mastopexy and breast reduction. Plast Reconstr Surg. 2011;128:1282–1301
7. Swanson E.. Prospective photographic measurement study of 196 cases of breast augmentation, mastopexy, augmentation/mastopexy, and breast reduction. Plast Reconstr Surg. 2013;131:802e–819e
8. Swanson E.. Prospective outcome study of 106 cases of vertical mastopexy, augmentation/mastopexy, and breast reduction. J Plast Reconstr Aesthet Surg. 2013;66:937–949
9. Pollock H, Pollock T.. Is reoperation rate a valid statistic in cosmetic surgery? Plast Reconstr Surg. 2007;120:569
10. Spear SL, Pelletiere CV, Menon N.. One-stage augmentation combined with mastopexy: Aesthetic results and patient satisfaction. Aesthetic Plast Surg. 2004;28:259–267
Back to Top | Article Outline


Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor 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.

The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.

©2015American Society of Plastic Surgeons