Breast Autoaugmentation: An Enduring Myth

Over 100 publications claim to improve breast upper pole fullness (“autoaugmentation”) by manipulating breast tissue alone.¹  Some investigators claim that rearranging breast parenchyma, usually involving an inferior pedicle, can duplicate the effect of a 200 cc implant.

In order to determine whether autoaugmentation is effective, I evaluated 82 publications using a new 2-dimensional breast measurement system (Figs. 1 and 2).¹  I also used this system to compare my own inverted-T and vertical mammaplasties.²

Measurements reveal that autoaugmentation methods do not improve upper pole fullness as claimed.¹  Fascial sutures appear to be ineffective.¹  The Wise pattern with an inferior pedicle, still commonly used in North America, predictably reduces breast projection and creates boxy lower poles.^1,2  These changes may be predicted by geometric considerations.^1,2  A vertical mammaplasty trades width for projection, creating a modest boost in breast projection and upper pole projection.^1,2  Only breast implants substantially increase upper pole fullness (Fig. 2).

Laser fluorescence imaging reveals that simultaneous vertical mastopexies using short, medial pedicles in combination with implants is a safe combination (Fig. 3). 

These measurement studies have important implications for clinical practice.  First, autoaugmentation is likely to disappoint patients.  Second, a woman who lifts up on her breasts and says “this is what I want” is most likely to be satisfied with a vertical augmentation/mastopexy, the only procedure that has been shown to create the illusion of a breast lift on the chest wall by adding to the upper pole and subtracting from the lower pole, the “minus-plus” principle.  Third, augmentation/mastopexy is safe and effective, as long as the vertical technique is used, not a Wise pattern and inferior pedicle, which jeopardizes nipple circulation.

Measurements confirm that, if a method is anatomically and geometrically valid for treatment of a small or moderate-sized breast, the principles also apply to a large breast.  An “All Seasons Augmentation/Mastopexy” challenges the traditional concept of using different mammaplasties for different breast sizes.  A woman who is a candidate for a mastopexy or augmentation performed individually is a candidate for the combined procedure.  Staging is unnecessary.  Measurements on standardized photographs (Figs. 1 and 2) are critical to our understanding of changes in breast shape and size after surgery.

References

1.      Swanson E. A retrospective photometric study of 82 published reports of mastopexy and breast reduction. Plast Reconstr Surg. 2011;128:1282-1301.

2.      Swanson E. Comparison of vertical and inverted-T mammaplasties using photographic measurements. Plast Reconstr Surg. – Glob Open. 2013;1:e89.

Fig. 1.  Frontal photographs before (left) and 3 months after (right) vertical augmentation/mastopexy (360 cc saline implants) in a 35-year-old woman (resection weights: right 116 g; left, 128 g). 

Fig. 2.  Lateral photographs of the same patient before (left) and 3 months after (right) augmentation/mastopexy. MPost, maximum postoperative breast projection.

Fig. 3.  Intraoperative laser fluorescence imaging, before (above) and immediately after (below) inflation of 450 cc implants in a 52-year-old woman with a previous inverted-T breast reduction undergoing a secondary vertical mastopexy and simultaneous implants.  Nipple circulation is not compromised despite previous surgery and large implant volumes.