Vertical Scar Mastopexy With a Centrally Based Auto-Augmentation Flap

Abstract

The authors describe their technique for vertical scar mastopexy with a centrally based auto-augmentation flap. Since 2011, the authors have performed this procedure in 212 patients and found that this operative technique has allowed us to achieve reproducible aesthetic outcomes while minimizing complications. Vertical scar mastopexy with a centrally based auto-augmentation flap is an excellent procedure for patients with breast ptosis who desire improved breast shape and superior pole fullness without the use of a breast implant. The perioperative management and detailed steps of the procedure are outlined.

Figure 1.

Preoperative markings of a 50-year-old female who underwent vertical scar mastopexy with a centrally based auto-augmentation flap using bilateral superomedial pedicles to reposition the nipple-areola complexes.

Figure 2.

Mosque dome marking pattern: (A) new location of the superior border of the new nipple-areola complex; (B) inferior limit of the skin excision; (C, D) blocking triangles.

Figure 3.

Pedicle selection. If any of the new nipple-areola complex (NAC) is located above a line joining points C and D, then a superior pedicle is designed. If the entire new NAC is located below this line, a superomedial pedicle is used.

Figure 4.

In cases where the new nipple-areola complex (NAC) is abutting the medial pillar, it cannot be transposed into the roof of the mosque dome pattern using a superomedial pedicle so a superolateral pedicle is used to facilitate the inset of the new NAC.

Figure 5.

Preoperative (A, C, E) and 17-month postoperative (B, D, F) photographs of a 50-year-old female who underwent vertical scar mastopexy with a centrally based auto-augmentation flap using bilateral superomedial pedicles to reposition the nipple-areola complexes. She had 110 g excised from the right and 90 g excised from the left and liposuction of the lateral chest with aspiration of 50 mL from each side. Her preoperative markings are shown in Figure 1, and her surgery is shown in the Video.

Figure 6.

Preoperative (A, C, E) and 7-month postoperative (B, D, F) photographs of a 47-year-old female who underwent vertical scar mastopexy with a centrally based auto-augmentation flap using bilateral superior pedicles to reposition the nipple-areola complexes. She had 5 g excised from the right and 5 g excised from the left.

Figure 7.

Preoperative (A, C, E) and 19-month postoperative (B, D, F) photographs of a 38-year-old female who underwent vertical scar mastopexy with a centrally based auto-augmentation flap using bilateral superior pedicles to reposition the nipple-areola complexes. She had 93 g excised from the right and 91 g excised from the left.