Breast Auto-Augmentation: A Versatile Method of Breast Rehabilitation-A Retrospective Series of 107 Procedures

Abstract

Background: Breast auto-augmentation (BAA) using an inferior pedicle dermoglandular flap aims to redistribute the breast tissue in order to increase the fullness in the upper pole and enhance the central projection of the breast at the time of mastopexy in women who want to avoid implants. The procedure achieves mastopexy and an increase in breast volume.

Methods: Between 2003 and 2014, 107 BAA procedures were performed in 53 patients (51 bilateral, 2 unilateral and 3 reoperations) with primary or secondary ptosis of the breast associated with loss of fullness in the upper pole (n=45) or undergoing explantation combined with capsulectomy (n=8). Six patients (11.3%) had prior mastopexy and 2 (3.7%) patients had prior reduction mammoplasty. The mean patients' age was 41 years (range, 19-66 years). All patients had preoperative and postoperative photographs and careful preoperative markings. Follow-up ranged from 6 months to 9 years (mean, 6.6 months).

Results: The range of elevation of the nipple was from 6 to 12 cm (mean, 8 cm). The wounds healed completely with no complications in 50 (94.3%) patients. Three patients had complications including 2 (3.7%) hematomas and 1 (1.9%) partial necrosis of the nipple-areola complex. Three (5.7%) patients were dissatisfied with the level of mastopexy achieved underwent a further procedure. No patient complained of scar hypertrophy.

Conclusions: BAA is a versatile technique for women with small breasts associated with primary or secondary ptosis. It is also an effective technique for the salvage of breasts after capsulectomy and explantation.

Keywords: Breast; Mammaplasty; Surgical flaps.

Fig. 1. Preoperative markings for breast auto-augmentation

The patient is marked in the standing position with the arms at the side to mark the new nipple location and then, following this, with the hands on the hips as well as on top of the head to complete the inferior markings. The new nipple position is at the level of the infra-mammary crease. The cephalic limit of the neo-areola is marked 2 cm above the new nipple location.

Fig. 2. Preparation of the inferior parenchymal flap

The areola is circumscribed with a 42 mm areola marker. De-epithelialization is performed. The inferior pole of the vertical limb is undermined at the sub-dermal level to free up the inferior parenchymal pedicle and to reduce the inferior skin redundancy. The inferior parenchymal pedicle is isolated with a medial incision at 90 degrees to the chest wall and the lateral incision is made obliquely to the chest wall to preserve the vascular supply. (A) De-epithelialisation of the pedicle. (B) Undermining the inferior pole of the pedicle. (C) Medial and lateral incisions. (D) Superior incision.

Fig. 3. Preparation of the NAC

The nipple areolar complex (NAC) is fixed superiorly in the midline at the 12 o'clock position with a 4-0 monofilament glycomer suture. The superior poles of the vertical limbs are apposed with a 3-0-monofilament polyglyconate suture to which a hemostat is applied. Cephalic tension is applied to this suture whilst the remainder of the inferior limb is closed with deep dermal sutures of 3-0 monofilament polyglyconate. If indicated, tailor tacking is performed at this stage prior to final closure. Fixation of the superior pole of the NAC. (B) Apposition of the superior poles of the vertical limbs. (C) Tailor tacking. (D) Closure and end result.

Fig. 4. Case 1 (breast auto-augmentation)

This patient is a 45 year-old white female with para 1, with bilateral ptosis Stage C. She underwent breast auto-augmentation with a 6 cm nipple areolar complex elevation. Front view, preoperative. (B) Front view, postoperative. (C) Right oblique view, preoperative. (D) Right oblique view, postoperative.

Fig. 5. Case 2 (salvage auto-augmentation)

This patient is a 51 year-old white female, para 2, non-smoker, with a history of bilateral sub-muscular implant augmentation done seventeen years prior, which had since migrated. She had a complete capsulectomy and salvage auto-augmentation. Front view, preoperative. (B) Front view, postoperative.