The decision to have breast augmentation, mastopexy, or augmentation–mastopexy surgery may not be so straightforward after all.
When a patient seeks a mastopexy or augmentation, it is reasonable to ask what bothers her about her breasts. If it is clear that the breast size is small and there is significant ptosis of the breasts, then an augmentation–mastopexy is indicated.
In part 1 of this article (“The Axillary Approach” by George John Bitar, MD, and Vinod K. Chopra; October 2007), we described the axillary technique for breast augmentation.
In part 2, we discuss a new breast augmentation–mastopexy technique, as well as how to avoid the pitfalls of the axillary augmentation procedure.
For patients wishing to have a mastopexy performed simultaneously with a breast augmentation, I have developed a simple and practical way to perform this procedure with natural results and reduced operative time (Figures 1, 2, and 3).
Figure 1:A 45-year-old woman who received an axillary-approach breast augmentation, a Benelli mastopexy, and an abdominoplasty is shown 1 year postsurgery.
The idea originated while at a conference listening to a lecture about performing a lower blepharoplasty with a simultaneous subciliary incision to remove the excess skin and a subconjunctival incision to remove the fat—without disturbing the middle lamella, rather than removing the fat through the subciliary incision.
The augmentation–mastopexy is performed in the following way.
First, a breast augmentation is performed as described in part 1, up until the step in which the submuscular pocket has been created by the implant sizers through an axillary approach.
The implant sizers are left in place, and a Benelli or Wise pattern mastopexy is performed according to the surgeon’s preference. When the mastopexy is completed and the incisions are closed, the sizers are removed. Next, the permanent implants are placed through the axillary incision. The patient is placed in an upright position on the operating table for a final inspection.
When the shape and size of the breasts are satisfactory, the filling tubes are removed and the axillary incisions are closed. Finally, the dressings are placed, a bra is fitted, and the patient is awakened from the anesthesia.
The benefits of creating two separate surgical sites for the axillary breast augmentation and mastopexy outweigh the advantages of a “single surgical site,” traditional augmentation-mastopexy with the insertion of the implants through the periareolar or anchor incision.
The pectoralis muscle is minimally manipulated, thus decreasing postoperative inflammation and pain, and preserving intact muscle coverage for the implant in case of an incisional wound infection or dehiscence.
Figure 2. A 55-year-old woman 3 months after receiving a breast augmentation/mastopexy shows early healing results.
The option to adjust the implant size based on tension on the NAC incision exists without difficulty; by inflating or deflating the sizer implants to achieve the desirable volume prior to committing to the final implant size.