BACKGROUND:  The ptotic breast deformity results from two opposing forces:   involution of breast parenchyma leading to a loss of volume while, conversely, the skin envelope becomes progressively lax, inelastic, and accomodating.  As the breast tissue descends inferiorly on the chest wall from gravity, there is an apparent volume loss in the upper pole and the central breast, while the lower pole becomes fuller and often wider.  We propose a technique whereby the superior pedicle vertical mammaplasty technique originally described by Lassus is modified to include transposition of glandular tissue to restore central mound projection while simultaneously narrowing the lower breast base and raising the inframammary crease. Simply stated, the breast tissue that is usually retained in an inferior breast reduction is now elevated on a superior dermal pedicle blood supply and transposed into a prepectoral pocket under the central breast. The medial and lateral pillars are then sutured together to narrow the breast base.
METHOD:  From 2003 to 2007 thirty-four patients underwent a superior-pedicle autoaugmentation mammaplasty.  Ages ranged from 22 to 47 years.  The mean follow-up period was 24 months.  Patients were selected pre-operatively based on presence of wide, low-lying breasts lacking central projection.  In all cases, the patients expressed a desire to have a more youthful breast without the addition of an implant.
RESULTS:  All patients tolerated their procedure well. Two patients developed seromas that were drained in the office.  Thirty-four of 34 patients stated they were satisfied with the shape and the size of their breasts post-operatively. No patient went on to desire breast augmentation.
CONCLUSION:  Using the vertical-scar mastopexy originally described by Lassus and later refined by Lejour, Hall-Findlay and Plaza, et al, we create a dermoglandular extension of the superior pedicle that can be transposed behind the nipple-area complex.  This restores central mound projection while also narrowing the lower breast base and raising the inframammary crease.  In carefully selected patients with low lying wide breasts who do not desire breast implant augmentation, this technique can be employed to reliably recreate a more youthful breast shape without the use of a prosthetic.