Use of myofascial flaps in aesthetic breast surgery.

Background: The long-term stability of the breast shape, once it is achieved, should be included among the principal concerns of aesthetic mammaplasty. This goal presents a particular challenge to the surgeon treating a patient who is concerned with breast lift but also wants to preserve or even increase cup size.

Objective: This report details the use of a lower myofascial supportive flap (MFF) to prevent secondary breast ptosis in various clinical situations.

Methods: The conceptual approach was to use the MFF to reconstruct or make up for deficiencies of the superficial fascial system collagen network, which in this surgeon's view plays a key role in determining breast position and shape. The MFF flap was raised in the region of the pectoralis major and adjacent muscles based at the inframammary fold (IMF) level and sutured near the lower areola border, with the goal of recreating the IMF, stabilizing the nipple-fold distance, and providing long-term support to counteract the effects of gravity through the creation of a "balcony" flap within which the lower breast pole rests. The procedure was performed in various clinical situations, including primary mastopexy, secondary mastopexy to correct for "bottoming out" after previous surgery, mastopexy with augmentation, implant exchange plus mastopexy, and simple primary augmentation.

Results: The use of the MFF provided an aesthetic breast shape while maintaining upper-pole fullness. Morbidity was highest among patients who underwent primary or secondary mastopexy and lowest among those who underwent simple primary augmentation. However, in the latter group, morbidity was notably higher than in patients who underwent simple primary augmentation without the use of the MFF.

Conclusions: The MFF technique can provide better long-standing breast support than other procedures aimed at preventing or minimizing secondary breast ptosis. It is indicated most clearly for patients who are unwilling to give up breast volume for improved breast shape and who are unhappy with the results of previous standard mastopexy or augmentation. It is less useful in patients undergoing primary breast lift. Limitations include increased duration of surgery and increased trauma.