Background
Many augmentation mastopexy patients can develop implant ptosis, traction rippling, widened areola, and nipple dystopia secondary to the weight of the implant and the relaxation of the lower pole skin over time requiring secondary corrections. Therefore, algorithms to address the long term prevention of the undesired outcomes in augmentation mastopexy need to be addressed. This study examines various techniques to determine how to provide the best long term outcome for preservation of inferior pole support in this challenging group of patients.
Methods
This was a prospective cohort study of all augmentation mastopexy patients by one surgeon utilizing the same vertical mastopexy technique. A total of 182 patients (Age range: 21-48; average follow-up: 3.7 year) were enrolled between 2002 and 2009 but only 107 were followed for more than one year. An algorithm was developed to assign the patients to 4 groups:
1) Primary patients with minimal parenchymal tissue and overstretched skin required autologous inferior bra (IAB) dermal flap support (N=29).
2) Primary vertical mammoplasty technique utilizing a superiomedial pedicle and adequate paranchymal tissue obviating the need for dermoglandular support (N=29).
3) Primary patients with Secondary correction of augmentation mastopexy with autologous internal dermal flap (IAB) (N=27)
4) Secondary Correction of augmentation mastopexy patients with acelllular dermal matrix (ADM) (N=22).
Objective parameters such as nipple dystopia, and nipple to IMF distance were measured. Subjective parameter of capsular contracture was also measured and recorded.
Results
All patients who received the Autologous dermal flap or ADM showed minimal inferior descent of the implant and maintained good nipple position and projection based on subjective and objective parameters at one year. However, by 3 years, there was a statistically significant difference (p<0.05) in the objective parameters in patients who received either IAB or ADM (groups 2,3,4) vs group 1. There was a higher incidence of recurrence of capsular contracture in group 4 which was not statistically significant.
Conclusion
The Internal Autologous bra dermal flap and Acellualr dermal matrix provide alternative strategies to ensure long term inferior pole support of the augmentation mastopexy patients. We describe the detailed anatomic technique for the consistent execution of these two techniques and provide an algorithm for the categorization of these challenging patients. We believe that these techniques will allow a similar expectation of long term results like face lift or rhinoplasty and will ultimately lead to better outcomes in all mastopexy patients.