Mastopexy and breast implant

Mastopexy associated with breast implants is a technically complex operation. The Author provides some elements of his technique for solving clinical cases of his personal experience

Introduction – In clinical cases with  mammary ptosis  associated to glandular hypotrophy the problem of surgical choice arises whether using breast implants or not. The advantages of the introduction of the prosthesis are represented not only by the increase in volume  and  consistency, but also by a smaller amount of skin to be removed and therefore by shorter scars. On the contrary, the disadvantages are directly correlated to breast implants and their  possible related complications    (capsular contraction, dislocation, ALCL, etc. ..) that  should   always be taken into consideration. Patients must be adequately informed on the meaning of a “cohabitation” of the  implant and be instructed on the need for periodic clinical and instrumental postoperative checks.

Materials and Methods –  During the preoperative examination  the skin/gland discrepancy is evaluated. In case of severe tissue  excess, following   breast involution or weight-loss,  our conduct is to use breast implant whith a shape and volume compatible with a satisfactory result, but not exessively large   because their eight inevitably leads to a rapid recurrence of the mammary ptosis.   Based on the cutaneous and glandular trophism, we decide for sub-glandular or sub-muscular pockets.  In  case of a valid tissue covering, our preference is the subglandular pocket which allows a natural  aesthetic result.

In our clinical pratice, mastopexys is performed using dr. Millan’technique, a procedure  “à la demand “, which  basically consist of : undermining the gland   from the prepectoral  fascia and skin/gland dissection of  a part of the inferior pole, vertical division  of the gland  in two flaps , reconstruction  of the glandular  cone by an appropiate rotation of glandular flaps, skin redraping and excision of skin excess, repositioning of the NAC.

Results – The association of using  implants during the above described technique for mastopexy is, in our hands, a good  solution to correct mild-to-severe  hypotrophic ptotic breasts. In this way the shape and size of the breasts are correct and the results are stable over time.

Conclusion – In ptotic breast with mild-to-severe hypomastia and marked skin excess our  first choice is  mastopexy and implants   (subglandular or subpectoral pocket) which  increase the  volume and firmness  of the gland,    thus achieving a good upper pole projection and shorter scars. The advantage of  this technique is to obtain a valid correction of mammary ptosis with results that last long.