53. Mastopexy

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398 Part VIII&Breast Surgery

2. Marotta JS, Widenhouse CW, Habal MB, et al. Silicone gel breast implant failure and frequency of additional surgeries: analysis of 35 studies reporting examination of more than 800 explants. J Biomed Mater Res 1999;48:354

PREOPERATIVE PLANNING

9. A 34-year-old female wants to undergo a large breast augmentation with 450 cc bilateral implants. Which of

the following is true of implants >400 cc?

D. They are considered high–volume implants and are more prone to complications.

High–volume implants >400 cc are more prone to complications and many surgeons have special consent forms for such implants. Some of these complications in particular include double bubble deformity, bottoming out of the implant, lateral displacement especially if placed in the submuscular plane, implant rupture, and postoperative asymmetries.

1,2

REFERENCES

1. Collis N, Coleman D, Foo IT, et al. Ten-year review of a prospective randomized controlled trial of textured versus smooth subglandular silicone gel breast implants. Plast Reconstr Surg 2000;106:786

PREOPERATIVE PLANNING

10. Which of the following is an advantage of a subglandular/subfascial implant?

B. Avoids implant distortion with pectoralis activity (in a muscular patient).

The advantages of subglandular/subfascial implants include: Avoids implant distortion with pectoralis activity and, in muscular patients, is more anatomic and has better implant projection. However, it has a higher contracture rate when compared to subpectoral and dual plane dissections. Dual plane increases implant–parenchymal interface, which expands lower pole and prevents double-bubble deformity. Finally, subglandular/subfascial implants can interfere with mammography.

REFERENCE

1. Li S, Mu D, Liu C, et al. Complicationsfollowing subpectoralversus prepectoral breast augmentation: a meta-analysis. Aesthetic Plast Surg 2019;43(4):890–898

PREOPERATIVE PLANNING/ANATOMIC PRINCIPLES

11. What is a disadvantage to performing dual plane II and dual plane III?

A. Usually restricted to IMF incisions.

Dual plane II and dual plane III are usually restricted to inframammary fold (IMF) incisions. This allows for complete visualization of subglandular and submuscular pocket. Dual plane II and dual plane III dissections release the muscle more cephalically resulting in less inferior pole muscle coverage, thus increasing, not decreasing, lower pole arc stretch.

REFERENCE

1. Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 2001;107:1255

ANATOMIC PRINCIPLES/OPERATIVE TECHNIQUE

12. Which of the following differentiates dual plane type I, II, and III?

C. The extent and level of separation of pectoralis from parenchyma.

Chapter 52&Breast Augmentation 399

REFERENCE

1. Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 2001;107:1255

ANATOMIC PRINCIPLES/OPERATIVE TECHNIQUE

13. Which type of dissection involves separation of pectoralis from breast parenchyma in the retromammary

plane to the level of the inferior NAC?

B. Dual plane II.

In a dual plane dissection, the pectoralis major is completely divided from its origin at the level of the inframammary fold (IMF), stopping at the medial aspect of the IMF. The upper pole of the implant is placed under the pectoralis, and the lower pole is placed subglandularly. In Type I, there is no dissection in the retromammary plane to free the breast parenchyma muscle interface. In Type II, there is separation of pectoralis from breast parenchyma in the retromammary plane to the level of the inferior nipple areolar complex (NAC). In Type III, separation of pectoralis from breastparenchyma in the retromammary plane is continued to the level of the superior NAC.

REFERENCE

1. Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 2001;107:1255

OPERATIVE TECHNIQUE

14. A surgeon is looking to minimize contamination of a breast implant he or she is inserting. Which maneuver

is the best one to prevent implant contamination?

B. No touch technique.

To prevent implant contamination from the skin during surgical procedures, it is important to follow strict aseptic techniques. Aseptic techniques are practices used to minimize the risk of introducing harmful microorganisms (such as bacteria) into a surgical environment. The purpose of the no touch technique is to eliminate contact with the surgeon's glove and patient's skin, as skin contamination is thought to be a significant cause of capsular contracture. Use of a Keller funnel may help as well by allowing minimal contact time with surgeon's gloves. Use of sizers has no proven impact on final implant contamination. Rinsing the pocket out with betadine or triple antibiotic solution rather than saline alone will minimize contamination. Use of drains may actually increase implant contamination, as the implants are now exposed to the outside environment. Postoperative antibiotics do not confer any improvement in implant contamination risk.

REFERENCE

1. Mladick RA. “No-touch” submuscular saline breast augmentation technique. Aesthetic Plast Surg 1993;17:183

PREOPERATIVE PLANNING/POSTOPERATIVE CARE

15. What percentage of patients will experience permanent sensory changes following breast augmentation?

C. 15%.

About 15% of patients have permanent sensory changes. This is secondary to traction or transection of lateral intercostal cutaneous nerve. Incidence and severity are the same with all techniques.

1,2

REFERENCES

1. Courtiss EH, Goldwyn RM. Breast sensation before and after plastic surgery. Plast Reconstr Surg 1976;58:1

2. Mofid MM, Klatsky SA, Singh NK, et al. Nipple-areola complex sensitivity after primary breast augmentation: a comparison of periareolar and inframammary incision approaches. Plast Reconstr Surg 2006;117:1694

POSTOPERATIVE CONSIDERATIONS

16. Which of the following is true of postoperative rippling?

B. It is most commonly found in the upper pole of underfilled implants.

Rippling occurs secondary to underfilling or traction. It is seen in the upper pole of underfilled implants and can be prevented by filling saline implants to recommended fill or overfilling. Traction rippling is

400 Part VIII&Breast Surgery

seen in textured implants and can be prevented by ensuring adequate soft tissue over implant and matching pocket size with implant.

REFERENCE

1. Allergan Corporation. Saline implant premarket approval information, 2001. Available at www.fda.gov// downloads/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/breast-implants/ ucm064457.pdf

POSTOPERATIVE CARE

17. What is the leak/rupture rate associated with saline implants at 10 years?

B. 5–10%.

The risk of rupture for saline implants is at the rate of 2 to 5% at 5 years and 5 to 10% at 10 years. The rate of leak/rupture per year is 1%. The risk factors are underfilling (<25 cc), using intraluminal antibiotics, or employing steroids. Management is complex often requiring implant exchange.

REFERENCE

CAPSULAR CONTRACTURE/POSTOPERATIVE CARE

18. Which of the following Baker classifications is characterized by severe contracture and pain?

D. Grade IV.

The Baker classification is a system used to categorize the severity of capsular contracture, a complication that can occur after breast augmentation surgery involving the use of implants. Capsular contracture is the formation of scar tissue around the breast implant, and its severity can range from mild to severe. The Baker classification helps to standardize the assessment of these complications. There are four grades in the Baker classification:

Grade I (Normal): The breast is soft and looks natural. The implant is not palpable, and there is no visible

distortion of the breast.

Grade II (Mild): The breast is still relatively soft, but there might be slight firmness when palpated. The

appearance of the breast is generally normal, but there might be some minor distortion.

Grade III (Moderate): The breast feels firm to the touch, and there is noticeable distortion of the breast's appearance. This might involve visible changes in shape, position, or texture of the breast. Grade III is often associated with discomfort or pain.

Grade IV (Severe): The breast is hard to the touch, and there is significant distortion in the breast's appearance. The breast might feel very firm and unnatural. This grade is usually accompanied by pain or discomfort.

There is no Grade V in the Baker classification. Capsulectomy is indicated for grade III and grade IV capsular contracture.

REFERENCE

1. Gylbert L, A splund O, Jurell G. Capsular contracture after breast reconstruction with silicone gel and saline-filled implants: a 6-year follow-up. Plast Reconstr Surg 1990;85:373

CAPSULAR CONTRACTURE/POSTOPERATIVE CARE

19. Which of the following is historically true of capsular contractures?

C. Textured implants have a significantly lower contracture rate at 10 years when compared to smooth

implants.

Capsular contracture is the tightening of the capsule, with compression and distortion of the implant leading to asymmetry, pain, and implant rupture. The majority of capsular contractures will occur within 1 year, although late occurrences may occur secondary to systemic bacterial seeding or capsular maturation. Subglandular implants have a 32% contracture rate at 10 years compared to subpectoral implants, which have a 12% contracture rate. Smooth implants have a 58% contracture rate at 10 years

Chapter 52&Breast Augmentation 401

compared to the 11% contracture rate seen with textured implants. Silicone implants have a 50% contracture rate at 10 years compared to saline implants, which have a 16% rate of contracture. However, these rates are from earlier generation implants and currently newer implants have lower rates of capsular contracture.

REFERENCE

1. Gylbert L, A splund O, Jurell G. Capsular contracture after breast reconstruction with silicone gel and saline-filled implants: a 6-year follow-up. Plast Reconstr Surg 1990;85:373

BIA-ALCL: POSTOPERATIVE CARE

20. Which of the following is true of breast implant associated anaplastic large cell lymphoma (BIA-ALCL)?

D. It is associated with CD30 positive and ALK-negative T-cell lymphocytes.

BIA-ALCL is a rare and treatable type of T cell lymphoma that can develop around breast implants. It is not a cancer of the breast tissue itself. It should be discussed with any patient considering breast implants as part of the informed consent process. It has been associated with both silicone and saline implants in aesthetic as well as reconstructive patients. Diagnosis is based on ultrasound-guided fine needle aspiration (FNA) of the peri-implant fluid, which is assessed with immunohistochemistry for CD30-positive and ALK-negative T-cell lymphocytes.

1,2

REFERENCES

1. Clemens MW, Miranda FN, Butler CE. Breast implant informed consent should include the risk of anaplastic large cell lymphoma. Plast Reconstr Surg 2016;137:1117

2. ClemensMW, Medeiros LJ, Butler CE, et al. Completesurgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. J Clin Oncol 2016;34:160

53. Mastopexy

Shervin Etemad, Salam Kassis, Jacob G. Unger See Essentials of Aesthetic Surger y, pp. 751–761

BREAST PTOSIS

1. A 47-year-old woman, gravida 4 para 4, is considering mastopexy. On examination, bilateral nipple-areola

complexes (NAC) are well below the inframammary fold (IMF) and sit at the inferior contour of the breast. A significant glandular portion of her breasts is also located below the IMF. Based on this description, how would you classify her ptosis?

A. Grade I ptosis (mild). B. Grade II ptosis (moderate). C. Grade III ptosis (severe). D. Pseudoptosis. E. Does not fit into any classification scheme.

INDICATIONS AND CONTRAINDICATIONS

2. A 70-year-old woman with a history of reduction mammaplasty 20 years ago is interested in mastopexy to

address grade III ptosis. She has a history of transient ischemic attacks, for which she takes 325 mg of aspirin daily. She currently smokes one half-pack of cigarettes per day, and despite multiple attempts, has been unable to stop. She also has a history of hypothyroidism. Which of the following is a contraindication to mastopexy in this patient?

A. Age. B. History of prior mastopexy. C. Aspirin use. D. Active smoking status. E. Hypothyroidism.

INDICATIONS AND CONTRAINDICATIONS

3. In which of the following scenarios will a patient have the least benefit from mastopexy alone?

A. Grade I ptosis with low breast position on chest wall. B. Grade II ptosis with skin striae. C. Grade II ptosis with significant asymmetry of the areola. D. Grade III ptosis with fatty parenchyma. E. Grade III ptosis with history of massive weight loss.

PATIENT COUNSELING

4. A patient with grade II ptosis is undergoing bilateral vertical mastopexy. In your initial discussion with her,

she expresses concern for “losing too much volume” as a result of the operation and asks what postoperative cup size she should expect. An appropriate response to this concern would include which of the following?

A. She will maintain her current cup size. B. On average, a decrease of 2 cup sizes should be expected. C. On average, a decrease of 1 cup size should be expected. D. She will most likely have an increase of 1 cup size. E. She will most likely have an increase of 2 cup sizes.

MASTOPEXY TECHNIQUES

5. A patient presents with a significant concern for ptosis and a desire for a more “perky” breast appearance. On

examination, she has adequate upper pole fullness, fibrous parenchyma, and a nipple-areola complex (NAC) that is at the level of the inframammary fold (IMF). Which of the following approaches is most appropriate?

A. Inframammary fold wedge excision. B. Vertical mastopexy.

Chapter 53&Mastopexy 403

C. Wise-pattern mastopexy. D. Augmentation-mastopexy. E. Periareolar mastopexy.

MASTOPEXY TECHNIQUES

6. A 47-year-old woman is interested in mastopexy to address grade II ptosis. She expresses concern because her

54-year-old sister underwent mastopexy 10 years ago and recently required a second operation for recurrence of ptosis. You share that effects of mastopexy are often temporary, and recurrence is common in the long term. Which of the following techniques would limit the risk of recurrent ptosis most in this patient?

A. Periareolar deepithelialization and closure. B. Vertical mastopexy without undermining (Lassus). C. Inframammary fold wedge resection. D. Superior repositioning of inferior parenchyma. E. Inferior closure of medial and lateral breast pillars.

MASTOPEXY TECHNIQUES

7. A 59-year-old woman with a history of silicone gel implants 15 years ago expresses fear of implant rupture

and would “like them removed as soon as possible.” She is not interested in simultaneous implant exchange but would like to you to address her breast ptosis. On examination, she has grade II ptosis and adequate soft tissue coverage over the implant. In addition to explantation, you plan to perform mastopexy. Which of the following is the best approach to addressing this patient's ptosis?

A. Simultaneous mastopexy and explantation. B. Mastopexy 3 months after explantation. C. Mastopexy 6 months after explantation. D. Mastopexy 1 year after explantation. E. This patient does not have an indication for mastopexy.

MASTOPEXY TECHNIQUES

8. A 27-year-old woman is in your clinic for a second opinion regarding mastopexy. On examination, you note

disproportionately large areola and suspect parenchymal herniation into the areola bilaterally. Additional findings include a narrow breast base and high inframammary folds bilaterally. She shares her original surgeon's plan for bilateral inverted-T mastopexy and asks you to comment on the appropriateness of this operation. Which of the following is the best recommendation?

A. Inverted-T mastopexy. B. Periareolar mastopexy. C. Vertical mastopexy with undermining and liposuction (Lejour). D. Augmentation alone. E. Further evaluation and planning for correction of tuberous breast deformity.

PATIENT COUNSELING

9. Patient dissatisfaction following mastopexy is most often regarding which of the following?

A. Infection. B. Hematoma. C. Wound-healing problems. D. Visible scars. E. Skin laxity.

404 Part VIII&Breast Surgery

Answers

BREAST PTOSIS

1. A 47-year-old woman, gravida 4 para 4, is considering mastopexy. On examination, bilateral nipple-areola

C. Grade III ptosis (severe).

This patient's ptosis would most appropriately be classified as grade III ptosis (severe ptosis). The Regnault classification of ptosis is based on the relative position of the nipple-areola complex (NAC) to the inframammary fold. II ptosis (B) is characterized by an NAC that lies below the inframammary fold, but above the most dependent breast parenchyma. In grade III ptosis (C), the NAC lies well below the inframammary fold and at the most inferior part of the breast parenchyma. Pseudoptosis is characterized by an increased nipple-to-inframammary fold distance, an NAC that is above or at the level of the inframammary fold, and the presence of the bulk of dependent breast parenchyma below the level of the fold (Fig. 53.1).

In grade I ptosis (A), the NAC is at the level of the inframammary fold (A). Grade

Fig. 53.1 Regnault classification of breast ptosis. (a) Pseudoptosis. (b) Grade I ptosis. (c) Grade II ptosis.

(Source: Regnault classification. In: Janis J, ed. Essentials of Aesthetic Surgery. 1st Edition. New York: Thieme; 2018.)

REFERENCES

1. Regnault P. Breast ptosis. Definition and treatment. Clin Plast Surg 1976;3:193

2. Jones GE. Mastopexy. In: Jones GE, ed. Bostwick's Plastic & Reconstructive Breast Surgery. 3rd ed. New York: Thieme Publishers; 2010

INDICATIONS AND CONTRAINDICATIONS

2. A 70-year-old woman with a history of reduction mammaplasty 20 years ago is interested in mastopexy to

D. Active smoking status.

This patient's active smoking status (D) is a contraindication to mastopexy. Wound-healing complications are highly prevalent in smokers and an elective operation such as mastopexy should not be performed in active smokers. Age (A) is not a contraindication to mastopexy, nor is history of prior mastopexy (B). In fact, mastopexy provides a temporary solution for ptosis, and long-term recurrence of

Chapter 53&Mastopexy 405

ptosis should be an expectation as aging and gravity continue to affect the breast after mastopexy. Hematoma formation is a relatively infrequent complication of mastopexy and the rate of hematoma formation is increased in patients on aspirin.2When feasible, patients should hold aspirin (C) and antiplatelet medications for 10 days prior to their operation.

REFERENCES

1. Bostwick J III. Mastopexy. In: Bostwick J III, ed. Plastic and Reconstructive Breast Surgery. 2nd ed. New York: Thieme Publishers; 1999

2. Grotting JC, Chen SM. Control and precision in mastopexy. In: Nahai F, ed. The Art of Aesthetic Surgery: Principles and Techniques. New York: Thieme Publishers; 2005

INDICATIONS AND CONTRAINDICATIONS

3. In which of the following scenarios will a patient have the least benefit from mastopexy alone?

A. Grade I ptosis with low breast position on chest wall.

Patients with low breast position on chest wall without significant ptosis (A) will not benefit from mastopexy alone. ptosis, especially as they age. Patients with ptosis often have variations in areola size and shape (C), for which symmetry can be obtained with planned skin incisions during mastopexy. Parenchymal quality is important to consider, as inverted-T techniques may be more appropriate in patients with severe ptosis and fatty parenchyma (D). Recurrence of some degree of ptosis after mastopexy (E) is not uncommon, as gravity and aging continue to influence breast shape.

1,2

Striae are a sign of skin laxity (B), and are common skin findings in patients with

REFERENCES

1. Hidalgo DA, Spector JA. Mastopexy. Plast Reconstr Surg 2013;132:642e

2. Ibrahim AM, Sinno HH, IzadpanahA, et al. Mastopexy for breast ptosis:utility outcomesof population preferences. Plast Surg (Oakv) 2015;23:103

PATIENT COUNSELING

4. A patient with grade II ptosis is undergoing bilateral vertical mastopexy. In your initial discussion with her,

C. On average, a decrease of 1 cup size should be expected.

On average, patients experience a decrease of one brassiere cup size (C) following mastopexy alone due to small-volume parenchymal resection combined with skin envelope reduction. patients with at least a C cup undergoing mastopexy alone for grade II or III ptosis found an average decrease of 1 cup size following their operation.

Maintenance of current cup size (A) or decrease of more

A retrospective study of 20

than one cup size (B) are less likely. It is unlikely that patients undergoing mastopexy alone will have an increase in cup size (D, E). This is an important point to review in the patient counseling process and should be conveyed to patients at their initial visit.

REFERENCES

1. Swanson E. Prospective outcome study of 106 cases of vertical mastopexy, augmentation/mastopexy and breast reduction. J Plast Reconstr Aesthet Surg 2013;66:937–994

2. Weichman K, Doft M, Matarasso A. The impact of mastopexy on brassiere cup size. Plast Reconstr Surg 2014;134:34e

MASTOPEXY TECHNIQUES

5. A patient presents with a significant concern for ptosis and a desire for a more “perky” breast appearance. On

B. Vertical mastopexy.

Based on the Regnault classification of breast ptosis, the NAC is at the level of the IMF. Grade I ptosis is best addressed with either periareolar or ver tical (B) mastopexy techniques. A survey of board-certified plastic surgeons found periareolar techniques to have the highest rates of surgeon dissatisfaction and revision.

this patient has grade I ptosis (mild ptosis) in which

Inframammary fold wedge excision (A) may be

406 Part VIII&Breast Surgery

appropriate for patients with pseudoptosis in which the NAC is above or at the level of the inframammary fold and excess parenchyma has descended below the level of the fold. Wise-pattern mastopexy (C) may be employed in cases of more severe ptosis with the presence of excess skin, and it shares a skin incision pattern with the prevalent reduction mammoplasty technique. Augmentation-mastopexy (D) would be appropriate in cases where restoration of upper pole fullness is desired. Periareolar mastopexy (E) would flattenthebreast to some degree and can only achieve approximately 1 cm of lift.

REFERENCES

1. Regnault P. Breast ptosis. Definition and treatment. Clin Plast Surg 1976;3:193

2. Rohrich RJ, Gosman AA, Brown SA, et al. Mastopexy preferences:a survey of board-certified plastic surgeons.Plast Reconstr Surg 2006;118:1631

MASTOPEXY TECHNIQUES

6. A 47-year-old woman is interested in mastopexy to address grade II ptosis. She expresses concern because her

E. Inferior closure of medial and lateral breast pillars.

Although recurrent ptosis is an unavoidable risk in mastopexy, the risk can be mitigated with inferior parenchymal support, which may be obtained through inferior closure of medial and lateral breast pillars

(E).

Simple periareolar deepithelialization and closure (A) would not be appropriate in a patient with grade II ptosis. Vertical mastopexy without undermining (B) involves en bloc resection of ptotic skin, fat, and gland with superior transposition of the nipple, and will not contribute to inferior parenchymal sup-

port.

Inframammary fold wedge resection (C) is a technique that addresses pseudoptosis. Superior repo-

sitioning of inferior parenchyma (D) would contribute to restoration of superior pole fullness most.

REFERENCES

1. Rohrich RJ, Thornton JF, Jakubietz RG, et al. The limited scar mastopexy: current concepts and approaches to correct breast ptosis. Plat Reconstr Surg 2004;114(6):1622–1630

2. Lassus C. A 30-year experience with vertical mammaplasty. Plast Reconstr Surg 1996;97:373

MASTOPEXY TECHNIQUES

7. A 59-year-old woman with a history of silicone gel implants 15 years ago expresses fear of implant rupture

A. Simultaneous mastopexy and explantation.

In a patient with adequate (>4 cm) soft tissue coverage and moderate ptosis who desires explantation and mastopexy, simultaneous procedures (A) are an appropriate consideration. months after explantation (B) may be appropriate in cases of severe ptosis and sparse soft tissue coverage. In cases of staged mastopexy following explantation, it is not necessary to prolong staging beyond 3 months (C, D), and the choice of mastopexy technique should be based on preoperative ptosis classification.

1,2

Staging mastopexy 3

REFERENCES

1. Rohrich RJ, Beran SJ, Restifo RJ, et al. Aesthetic management of the breast following explantation: evaluation and mastopexy options. Plast Reconstr Surg 1998;101:827

2. Rohrich RJ, Kenkel JM, Adams WP, et al. A prospective analysis of patients undergoing silicone breast implant explantation. Plast Reconstr Surg 2000;105(7):2529–2537

Chapter 53&Mastopexy 407

MASTOPEXY TECHNIQUES

8. A 27-year-old woman is in your clinic for a second opinion regarding mastopexy. On examination, you note

E. Further evaluation and planning for correction of tuberous breast deformity.

This patient's physical examination reveals key characteristics of a tuberous breast deformity (E): constricted breast base, high inframammary fold, and parenchymal herniation into the areola. The tuberous breast deformity encompasses a spectrum of presentations with variability in the aforementioned characteristics, stemming from inadequate breast development in the horizontal and vertical dimensions. techniques are inadequate and more complex surgical planning is required. These patients may benefit from periareolar mastopexy (B), with parenchymal modification through inferior pole radial scoring, and augmentation (D) to restore parenchymal volume. Inverted-T mastopexy (A) would be appropriate for cases of severe ptosis. Likewise, vertical mastopexy with undermining and liposuction (C) may be appropriate in cases of ptosis with larger breast size to reduceparenchymalvolume.

1,2,3

It is important to identify patients with tuberous breasts, as typical mastopexy

REFERENCES

1. von Heimburg HD, Exner K, Kruft S, et al. The tuberous breast deformity: classification and treatment. Br J Plast Surg 1996;49:339

2. Nahabedian MY. Breast deformities and mastopexy. Plast Reconstr Surg 2011;127:91e–102e

3. Kolker AR, Collins MS. Tuberous breast deformity:classificationand treatment strategy for improving consistency in aesthetic correction. Plast Reconstr Surg 2015;135(1):73–86

PATIENT COUNSELING

9. Patient dissatisfaction following mastopexy is most often regarding which of the following?

D. Visible scars.

Postoperative scars are a frequent source of patient dissatisfaction as well as litigation following mastopexy. In fact, mastopexy procedures have the greatest incidence of litigation among aesthetic breast procedures. scar placement, and scar quality. Both periareolar scar widening and medial horizontal inframammary fold scars are common sources of patient dissatisfaction. In the postoperative period, scar treatment should begin at 3 weeks with the surgeon's preferred approach, and scar revisions may be performed 1 year after the initial operation. Infection (A) is an uncommon complication for which prophylactic antibiotics are given in the perioperative period. Hematoma (B) is also uncommon in patients who are off aspirin and antiplatelet medications in the 10-day preoperative period. A tight hematoma is an indication for urgent reoperation for evacuationandhemostasis. Wound-healing problems (C) are more common with inverted-T mastopexy techniques and in smokers. For this reason, mastopexy should not be performed in active smokers. mastopexy.

The informed consent process should discuss, in detail, the risk of visible scarring,

Skin laxity (E) often accompanies ptosis and is not a complication of

REFERENCES

1. Hidalgo DA, Spector JA. Mastopexy. Plast Reconstr Surg 2013;132:642e

2. Stevens WG, Soker DA, Freeman ME, et al. Mastopexy revisited:a review of 150 consecutive cases for complication and revision rates. Aesthet Surg J 2007;27(3):150–154

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