Purpose: This study was designed to describe a case of mastopexy augmentation with a modified vertical technique by the main author, highlighting a double plane implant pocket closure and a symmetrical, short and horizontal scar located at the new submammary line to prevent skin redundancy. Methods: We present a case study of a 30 years old female with preoperative assessment of bilateral grade 2 ptosis, with moderate vertical excess and breast overhanging the inframammary fold (IMF). A vertical elliptical resection pattern was marked preoperatively. A superior based pedicle and intraoperative nipple siting. The implants were placed through a horizontal incision just below the inferior border of the areola, under the subfascial plane. The implant should always be placed before any tissue is removed for the pexy. Insert the implant providing the best possible coverage should be sought, avoiding incisions where implant extrusion is more probable. After the implant was placed, the distance from the nipple to the IMF was assessed, we measured 7cm for optimal nipple-to-IMF distance. Dermoglandular flaps of the medial and lateral pillars were fixed vertically, after vertical excess resection. The skin redundancy inferior to the intersection of this vertical line and the new submammary line, was excised by creating a triangular pattern seemed like dog ears. The resection of the triangular pattern resulted in a symmetrical, short and horizontal scar located at the new submammary line. Results: With this superior pedicle modified vertical scar mammoplasty technique, the main author provides a double opposing plane closure for the implant pocket pattern diminishing implant extrusion risk. The risk of Persistent ptosis is decreased avoiding skin redundancy at the vertical scar with a short horizontal scar at the new submammary line. Posoperative view 2 months after the patient underwent augmentation/mastopexy with a 255cc high profile silicone gel implants with satisfactory results. No scar, nipple, residual ptosis complications. Conclusions: The combined mastopexy augmentation offers technical advantages and permits safe single-stage surgery. Our preferred approach is to insert the implant first, evaluate the degree of ptosis correction, and then proceed with a modified vertical mastopexy, with a short, Inverted-T modification preventing skin redundancy. Simple details such as these are of vital importance for ensuring the success of the surgery and for maximum avoidance of complications. This results in high patient satisfaction, superior results with little scarring, and fewer secondary procedures.
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