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


  • 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.

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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