Case 38 Mastopexy/Augmentation

Rachel R. Sullivan

Patient with severe deflation of bilateral breasts and grade 3 ptosis
Breasts appear to have a very long sternal notch to nipple-areola complex (NAC) distance
Notable sagging and laxity of skin

Determine patient’s motivation for seeking surgery and desired result: Breast lift, increased volume, correction of asymmetry, or a combination
Prior history of breast or thoracic procedures: May impact blood flow
Identify and discuss comorbidities that may affect healing (e.g., diabetes, cardiopulmonary disease)
Smoking history
Personal risk/family history of breast cancer and prior mammography
Pregnancy and breastfeeding history, and plans for future pregnancy
Current breast size and desired breast size

Systematic evaluation of the breast (Fig. 36.1, Table 36.1)
- Relationship of nipple to inframammary fold (IMF)
- Relationship of breast tissue to IMF
- Overall size and surface area of the breast
- Quality of skin (elasticity, thickness, striae) and breast parenchyma
- Breast and/or chest wall asymmetries
- Palpate for masses and/or nipple discharge
- Assess nipple–areola complex (NAC) sensation
Key measurements
- Sternal notch to nipple distance, nipple to IMF during stretch, breast base width, superior and inferior pole pinch thickness, anterior pull skin stretch, and estimated parenchymal fill
Preoperative photographic documentation

Discussion of patient’s expectations versus anticipated outcomes
Possible complications and/or recurrence of ptosis
Potential need for revisions and how revision costs may be handled
Implant type
- Saline versus silicone (see Table 38.1 for comparisons)
- Round versus shaped
- Smooth versus textured
- Discuss Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) (see chapter 35)
Implant placement (subglandular, subpectoral, dual plane)
Possible negative effects on future breastfeeding
Postoperative breast cancer surveillance
Expected postoperative course and return to function

Possible use of drains, postoperative garments, and instructions

Postoperative activity and return to work

Table 38.1 Comparison between saline and silicone implants
	Pros	Cons
Saline	Easily adjustable size Low contracture rates Rupture identified clinically	Rippling Less natural feel
Silicone	More natural feel Lighter weight than saline Lower notable rippling	Higher contracture rates Larger incisions for placement MRI necessary to evaluate for rupture
Abbreviation: MRI, magnetic resonance imaging.