Case 38 Mastopexy/Augmentation

Rachel R. Sullivan

Case 38 Mastopexy/Augmentation

Case 38 A 49-year-old female with chief complaint of loose skin and volume loss of the breasts after massive weight loss.

38.1 Description

  • 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

38.2 Work-Up

38.2.1 History

  • 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

38.2.2 Physical Examination

  • 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

38.3 Patient Counseling

  • 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




      Easily adjustable size

      Low contracture rates

      Rupture identified clinically


      Less natural feel


      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.


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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 38 Mastopexy/Augmentation
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