Chapter 18 Mastopexy
Summary
Indication
Regardless of the etiology, a useful tool for the surgeon is to classify patients by the degree of ptosis present. The classification system used most frequently was first described by Regnault1 and grades the breast based on the position of the nipple relative to the inframammary fold (IMF) (Table 18.1).7 The amount of preoperative ptosis can be used as a guide to selecting the operation necessary to achieve correction.
Grade I | Nipple at the level of the IMF, above the lower contour of the gland |
Grade II | Nipple below the IMF, above the lower contour of the gland |
Grade III | Nipple below the IMF and at the lower contour of the gland |
Pseudoptosis | Normal nipple position with glandular tissue below the IMF |
IMF, inframammary fold.
Preoperative History and Considerations
For each patient, the surgeon should develop a strategy for reshaping and positioning the breast parenchyma and determine the need, if any, for additional soft tissue augmentation with an implant or autologous flap. Breast shaping can be elaborate or simple and may include combinations of suturing, local flaps, muscle slings, or placement of internal mesh support.2–5
Combining augmentation with mastopexy can be accomplished safely for many patients. Clearly, adding an implant to an already complex operation will increase the number of variables that the surgeon must consider. Many women with ptotic breasts focus more on the loss of upper pole volume that has occurred as their breasts have aged, than on the change in nipple position that has accompanied it. An implant can be a very powerful tool in restoring youthful fullness to the upper pole.
Preoperative planning and dimensional analysis
Preoperative physical exam should include measurements as well as an assessment of tissue qualities and distribution. Significant asymmetries will be noted in most patients when carefully examined.6 It is important to recognize and point out any pre-existing asymmetries, spinal curvature, or chest wall deformities because these may be difficult to correct and can become noticeable in the postoperative period. Preoperative photographs with multiple views are obtained on all patients and maintained as part of the office record.
The soft tissue envelope should be characterized and the desired resultant breast form planned (Box 18.1). Once accomplished the surgeon can assimilate the information to select an appropriate implant, if desired, and plan the mastopexy approach. Use of the BioDIMENSIONAL® preoperative planning system (INAMED Corporation) can be used on patients requiring ptosis correction with augmentation.