Mastopexy/Augmentation



10.1055/b-0034-97718

Mastopexy/Augmentation

Simone W. Glaus & Marissa Tenenbaum
A 57-year-old woman presents with a chief complaint of “sagging breasts.”


Description




  • Grade III ptosis (see Table 26.1): Nipple below the inframammary fold (IMF) and at the most inferior portion of the breast.



  • Deflated breasts with large skin envelope relative to parenchymal volume.



  • Poor skin elasticity.



  • Asymmetry of breast size and nipple position.



Work-up



History




  • Determine patient′s motivation for seeking surgery and primary desired result (lift, increased volume, correction of asymmetry, or combination).



  • Prior history of breast procedures (may impact blood flow to nipple–areola complex [NAC]).



  • Personal risk or family history of breast cancer, prior mammography.




    • See Case 27 (American Cancer Society guidelines).



  • Pregnancy and breastfeeding history, plans for future pregnancy.



Physical examination




  • Systematic evaluation of the ptotic breast




    • Relationship of nipple to inframammary fold.




      • Regnault classification of breast ptosis (see Table 26.1).



    • Relationship of breast tissue to inframammary fold (vertical overhang).



    • Overall size and surface area of the breast.



    • Quality of skin (elasticity, thickness, striae) and breast parenchyma.



    • Breast and/or chest wall asymmetries.



  • Key measurements




    • Sternal notch to nipple, nipple to IMF during stretch, breast base width, superior and inferior pole pinch thickness, anterior pull skin stretch, estimated parenchymal fill.



  • Clinical breast examination for masses.



Critical topics for discussion




  • Impact of breast augmentation on surveillance for breast cancer.



  • Potential complications (e.g., nipple loss, asymmetry) and relatively high rate (~ 20 to 25%) of revisionary surgery.




    • How revision costs will be handled.



  • Rates and detection of rupture for saline versus silicone versus form-stable silicone implants.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Mastopexy/Augmentation
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