Two-Stage Breast Augmentation-Mastopexy

Sir: Combined breast augmentation/mastopexy remains one of the most controversial operations in the cosmetic surgeon’s armamentarium. Numerous studies have analyzed the outcome of one-stage breast augmentation combined with mastopexy. The present study analyzed how many patients with ptosis will return for mastopexy after a primary breast augmentation. Patients with breast ptosis (nipple at or below the inframammary crease) were given the choice of single-stage breast augmentation combined with mastopexy or breast augmentation with the proviso that mastopexy might be required after 6 months. Patients were reassured that should they desire the mastopexy later, they would pay only a reduced fee. Thus, there was no difference in cost to the patient between a one-stage and a two-stage procedure. The lateral preoperative photographs of 4432 consecutive patients who underwent primary breast augmentation were studied. A total of 376 patients were identified with the nipple at or below the inframammary crease. Seven of the 376 patients returned for mastopexy after the primary augmentation. Numerous studies have documented significant risks associated with combined breast augmentation and mastopexy.1–3 Even studies that have advocated combined augmentation/mastopexy have also reported rather prohibitively high morbidity rates.4–6 This large study shows that the two-stage option may prove beneficial to many women seeking primarily volume increase. Analysis of outcome in cosmetic surgery is based on the assumption that patients will return for secondary surgery rather than go elsewhere. With this in mind, adopting a policy of breast augmentation as an initial treatment strategy works well and is acceptable for most women with breast ptosis. Variations in patient demographic profiles and cultural diversity determine how postoperative ptosis is perceived or accepted by patients. In our practice, a two-stage breast augmentation/mastopexy policy has meant breast augmentation with no further surgery for most of our patients. In view of the increased morbidity rate of the combined procedure, we believe it is important not to deny women who are primarily seeking an increase in volume the option of augmentation alone, and we suggest offering delayed mastopexy at a reduced cost in order to reassure patients that they will not lose out financially. The high revision rate7 for one-stage breast augmentation/mastopexy may also offset the apparent cost savings of this procedure. In conclusion, offering breast augmentation in women with ptosis may result in fewer mastopexies being performed and reduced morbidity rates while remaining aesthetically acceptable. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article and received no funding for this study. Bassem Nathan, F.R.C.S. Riverside Hospital London, United Kingdom Mark Mikhail Imperial College London London, United Kingdom Zachary Nash Lawrence Mascarenhas, M.D. Guy’s and St Thomas’s Hospital London, United Kingdom