Short-Scar Augmentation Mastopexy in Massive-Weight Loss Patients: Four-Step Surgical Principles for Reliable and Reproducible Results

Background: Single-stage augmentation mastopexy is considered a challenging procedure, and its safety and efficacy remain controversial for breasts with grade-2 and grade-3 ptosis. In this paper, we report our experience in single-stage augmentation mastopexy with implants, using a short-scar technique, outlining the four-step principles of our technique which maximizes the cosmetic outcomes though being safe, reliable and reproducible. Patients and methods: Forty consecutive massive-weight loss (MWL) patients undergoing short-scar augmentation mastopexy with implants between September 2010 and August 2018 were retrospectively analysed. The preoperative evaluation and our four-step surgical principles are presented in detail. Breast shape analysis was performed separately by a blinded group of plastic surgeons and by the attending surgeon using a standardized evaluation method. Breast-Q was used to evaluate patients' satisfaction. Results: Patients' average age was 43 (range from 29 to 54). Among the 40 patients, 2 patients were rated as grade 1 (5%), 21 cases (52.5%) grade 2 and 17 (42.5%) grade 3 according to Pittsburgh Rating Scale. The average follow-up time was 40 months (ranging from 3 to 96 months). No major postoperative complications were experienced. Patients' satisfaction was high to very high. Conclusions: Augmentation mastopexy with implant in the MWL population remains a challenging procedure, especially in Pittsburgh grade-3 breasts. A bilamellar approach using proper footprint reconstruction allows for very satisfying cosmetic results using the short-scar mastopexy pattern with a very low complication rate. Our four-step surgical principles are provided, which may aid in the surgical planning and execution of such demanding cases. Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.