Can It be Safe and Beautiful? A Retrospective Review of Mastopexy with Concurrent Breast Augmentation

Background: 

Debate concerning the safety of performing mastopexy concurrently with breast augmentation still exists with concerns of breast tissue neurovascular compromise and overall high complications rates.  We describe a single stage procedure using a “Tailor-Tack” technique that consistently achieves an aesthetically pleasing breast while preserving tissue viability.

Methods:

This is a retrospective chart review of all consecutive breast augmentations performed concurrently with mastopexy by the senior authors (M.M. and O.T.), from 2006 to 2017 using the current “Tailor-Tack” technique.  We report patient demographics, breast implant placement, implant type, shape, and size, duration of follow-up, and complications.  Complications reviewed include recurrent breast ptosis, poor shape of the nipple areolar complex, hypertrophic scarring, implant rupture, capsular contracture, nipple tissue loss, breast skin loss, decreased nipple sensation, implant infections or extrusion, reoperation, and scar revisions. In brief, the key principles of the technique included first placing the breast implant in the submuscular space, then performing tailor tacking of the skin in a modified Wise pattern to approximate the skin resection for the mastopexy. The patient was then placed in the sitting position and final adjustments were made.

Results:

Fifty-six patients underwent augmentation with the “Tailor-Tack” mastopexy.  The average age of the studied patients was 41.2 years.  The average follow-up time period was 2.1 years (+/- 8.9 months).  Fifty-four patients (96.4%) had implants placed through a periareolar incision, two patients (3.6%) had implants placed through infra-mammary incisions.  All implants were placed in a dual plane.  Fifty-two patients (92.9%) received silicone implants and four patients (7.1%) received saline implants.  Patient preference determined implant choice.  All implants except five were textured. Average implant size was 277 ml (range 120-800).

Ten patients had complications (17.9%). Complications included hypertrophic scarring in 5 (8.9%) patients, 4 (7.1%) poor NAC shape, 3 (5.4%) implant ruptures, 3 (5.4%) capsular contracture, and 2 (3.6%) with recurrent ptosis. There was no reported nipple tissue loss, breast skin loss, decreased nipple sensation, or implant infections or extrusion. Six patients (10.7%) required return trips to the operating room for revisions and one patient (1.8%)  had a nipple areolar complex scar revised in the office yielding a 12.5% surgical revision rate.

Conclusions:  

Mastopexy can safely be performed concurrently with breast augmentation.  In our eleven-year review, there were no catastrophic complications such as skin loss, nipple loss, implant extrusion, or infection.  The complications that occurred were common complications known to occur with mastopexy alone and/or breast augmentation alone and occurred at rates comparable to or less than the national averages for those procedures when they are performed independently.  The paramount principle for the success of this technique is to adjust breast volume initially and then perform an intra-operatively planned skin resection to fit the new breast volume.