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.
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.
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.
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.