Surgical correction of the “small” postpartum ptotic breast

BACKGROUND: In our experience, most women seeking correction of the "small" ptotic breast have a history of previous pregnancies and breastfeeding. OBJECTIVE: We propose a classification of postpartum ptosis into 4 groups and describe the appropriate surgical treatment for each category of ptosis. METHODS: We defined categories of ptosis on the basis of the remnant mammary gland, skin condition, position of the nipple-areolar complex (NAC), and distance from the NAC to the inframammary fold (IMF). Patients in group 1 (n = 15), with the NAC in good position, were treated with the use of simple subglandular augmentation mammaplasty. Patients in group 2 (n = 8), with grade I ptosis in which the nipple required elevation of no more than 3 cm and the distance from the inferior border of the areola to the IMF was less than 4 cm, were treated with the use of crescent-moon mastopexy. Patients in group 3 (n = 20), who demonstrated a higher degree of skin flaccidity and grade I or II ptosis and in whom the distance from the NAC inferior border to the IMF was between 4 and 6 cm, were treated with the use of circumareolar mastopexy. Patients in group 4 (n = 24), with moderate to severe skin flaccidity and ptosis in whom the distance from the NAC to the IMF was more than 4 cm, were treated with the use of modified vertical mastopexy. RESULTS: Eight-five percent of patients were satisfied with their results. Unfavorable results were related to dissatisfaction with breast shape and postoperative scarring; such results occurred most often in group 4 patients. Complications were within reasonable limits, including 2 cases of hematoma and 3 cases of decreased NAC sensibility in group 3 patients and minor dehiscence in 3 patients in group 4. CONCLUSIONS: Careful patient evaluation and choice of technique, as determined by the classification proposed in this paper, enabled us to achieve high rates of patient satisfaction with low rates of complications and revision.