The tissue-based triad: a process approach to augmentation mastopexy.

Background: Among the most exigent operations in plastic surgery is the combination of augmentation and mastopexy. The surgical challenge is related to oppositional forces that complicate the operative predictability. The purpose of this study was to investigate use of the tissue-based triad process approach in patients undergoing augmentation mastopexy. Measured components of the approach include skin stretch, nipple to inframammary fold distance on maximal stretch, and vertical excess.

Methods: Patients were selected for the study if they had been treated with one- or two-stage augmentation mastopexy, or mastopexy alone. Data gathered included preoperative measurements, operative details, complications, and outcomes including reoperation rate.

Results: A total of 176 consecutive patients were identified as meeting study inclusion criteria. Mean follow-up was 1.5 years. Seventy-one of 176 patients underwent mastopexy alone. Of the 176 patients included, 105 were treated with augmentation mastopexy. Ninety-one of 105 augmentation mastopexy operations were performed in one stage. The average amount of vertical excess was 5 cm. Nine patients exhibited delayed wound healing, while six (6.5 percent) required reoperations for scar revision (n=1), delayed wound healing requiring revision (n=2), hematoma (n=1), seroma (n=1), and soft-tissue stretch (n=1). Fourteen of 105 patients were treated in two stages. Average vertical excess was 7.5 cm.

Conclusions: Use of the tissue-based triad process approach provided objectivity in determining which patients should undergo one- versus two-stage augmentation mastopexy. Use of this approach helps guide surgical decision making and is associated with lower reoperation rates.

Clinical Question/level Of Evidence: Therapeutic, IV.