Triple-Plane Augmentation Mastopexy

Abstract

Dual-plane augmentation mammaplasty has gained wide popularity in treating breast ptosis. However, in our experience, dual-plane augmentation mastopexy fails to treat severe cases of ptosis (grade 3) and glandular ptosis. Therefore, we conceived a method to manage these cases effectively. The aim was to achieve harmonious, natural fullness, better projection, and appropriate size with limited scarring. We named this technique triple-plane augmentation mastopexy as three planes are used: the first plane is the subfascial plane, the second is the subglandular plane, and the third is the subpectoral plane.

Methods: A retrospective review was performed of 75 consecutive cases of grade 3 or glandular ptosis treated in a single clinic by three separate surgeons adopting the same technique from January 2010 to January 2017. Triple-plane augmentation mastopexy begins by undermining the breast tissue through a tunnel until the second rib is in the prepectoral plane. Then, the subpectoral pocket for the implant is dissected with release of the lower border of the pectoralis major and avoiding release of the sternal border. Subsequently, the breast tissue is suspended at the lower border of the second rib, followed by subpectoral insertion of the implant and skin envelope excision.

Results: Surgical follow-up varied from a minimum of 6 months to a maximum of 6 years, with an average of 3 years. Among a total of 75 patients, 64 patients (85.3%) complied with follow-up and 49 (76.5%) of these patients were satisfied. Complications varied from early complications (14.6%) to late complications (21.5%).

Conclusions: Grade 3 and glandular ptosis represent a challenge to plastic surgeons. Traditional techniques may fail to achieve optimized results. Triple-plane augmentation mastopexy is a safe, reliable procedure that ensures long-term desired aesthetic outcomes with limited scarring.

Fig. 1.

Intraoperative pictures of suspension sutures before implant insertion.

Fig. 2.

A 39-year-old woman with one prior pregnancy presented with emptiness of the upper pole, grade 2 ptosis, and glandular ptosis. The patient refused the skin envelope procedure. This patient underwent triple-plane augmentation mastopexy with the subpectoral placement of 325-cc, textured, round, high-profile gel implants. (Top) Preoperative pictures. (Bottom) Postoperative results at the 10-month follow-up.

Fig. 3.

A 26-year-old woman with one prior pregnancy presented with emptiness of the upper pole, grade 3 ptosis, and glandular ptosis. This patient underwent triple-plane augmentation mastopexy with the subpectoral placement of 300-cc, textured, round, high-profile gel implants. The skin envelope procedure was periareolar mastopexy. (Top) Preoperative pictures. (Bottom) Postoperative results at the 1-month follow-up.

Fig. 4.

A 45-year-old woman with three prior pregnancies presented with emptiness of the upper pole and severe grade 3 ptosis. This patient underwent triple-plane augmentation mastopexy with the subpectoral placement of 300-cc, textured, round, high-profile gel implants. The skin envelope procedure was T-shaped mastopexy. (Top) Preoperative pictures. (Bottom) Postoperative results at the 6-month follow-up.