Does Absorbable Mesh Prevent Recurrent Ptosis after Mastopexy?

A Modified Periareolar Auto-augmentation Mastopexy: Using an Inferolaterally Pedicled Tongue-Shaped Parenchymal Flap

BACKGROUND

The increasing demand for correcting ptosis has made mastopexy one of the most common procedures in plastic surgery. While various techniques have been developed, clinical outcomes often require refinement. In this study, we employed an inferolaterally pedicled, tongue-shaped parenchymal flap to perform auto-augmentation mastopexy via periareolar approach.

METHODS

Periareolar double-ring incisions were designed, de-epithelialization was performed between the inner and outer circles. Following subcutaneous separation of the breast parenchyma, an inferolaterally based, tongue-shaped parenchymal flap was elevated and rotated to fill posterior space of the breast, raising the nipple-areola complex (NAC). The parenchyma on both sides of the incision was sutured together to reduce the breast base and enhance central breast projection. The breast measurements and BREAST-Q scores were used to assess clinical outcomes and patients' satisfaction. Patients were also asked to rate their nipple sensation.

RESULTS

A total of 34 female patients were retrospectively analyzed after being treated with our modified auto-augmentation mastopexy technique from January 2016 to June 2023. All patients healed without postoperative complications such as poor wound healing, hematoma, infection, or nipple necrosis. Four patients reported decreased nipple sensation postoperatively. Breast measurements revealed improved projection, nipple elevation, and significant reductions in both mammary base width and areola diameter. BREAST-Q scores indicated significant improvements in postoperative breast satisfaction and quality of life.

CONCLUSIONS

Our modified periareolar auto-augmentation mastopexy provides a viable solution for patients with mild to severe breast ptosis, excluding cases with insufficient breast volume, seeking breast ptosis correction without synthetic materials or implants. This technique delivers natural, aesthetically pleasing results, significantly enhancing both patient appearance and quality of life.

LEVEL OF EVIDENCE IV

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Internal Bra: A literature Review and Sub-Classification of Definitions

BACKGROUND

The term 'internal bra' refers to a range of techniques that aim to stabilise the position of the breast and improve longevity of surgical results. It is increasingly being used to describe techniques in surgical literature and on patient information platforms, including social media. However a lack of consistency in the use of the term is a potential source of confusion and conflicting information.

OBJECTIVES

This narrative review aims to improve understanding of what is meant by the term 'internal bra', by providing an overview of the different techniques it refers to and suggesting more specific terminology for use going forward.

METHODS

A literature search of the Medline, Embase, and Google Scholar databases was conducted to identify papers in which a surgical technique was described using the term 'internal bra'.

RESULTS

'Internal bra' techniques can be categorised into 5 groups: mesh techniques, acellular dermal matrix techniques, suture techniques, dermal flap techniques, and muscle techniques. Promising results exist for techniques in each group; however, research is generally limited by small studies with short follow up periods, and significant inconsistencies exist in use of the term 'internal bra'.

CONCLUSIONS

The titles of the five groups identified in this paper should be used going forward when discussing 'internal bra' techniques, in order to bring greater clarity to both surgical literature and patient information. Further research is also required to establish if 'internal bra' techniques truly improve longevity of surgical results and if one technique, or group of techniques, is superior.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.