Intramuscular and Subcutaneous Lipofilling in Mastopexy: Technical Considerations and Clinical Outcomes.

[BACKGROUND] Mastopexy remains the gold standard for correcting breast ptosis, yet persistent limitations include insufficient restoration of upper pole fullness and lack of long-term projection. While prosthetic augmentation addresses these concerns, implants are associated with complications and growing patient reluctance. Autologous fat transfer represents a biocompatible alternative, with regenerative potential and proven safety. However, systematic approaches to layered fat grafting during mastopexy remain underexplored.

[METHODS] We retrospectively reviewed 36 patients (mean age 38.5 years) who underwent mastopexy combined with intramuscular and subcutaneous lipofilling between June 2023 and June 2024. Fat was harvested via low-pressure aspiration, processed by decantation, and injected using micro-aliquot retrograde technique. Intramuscular placement targeted durable upper pole projection, while subcutaneous grafting refined contour and softness. Outcomes were assessed through standardized photography, clinical examination, complication monitoring, and patient-reported satisfaction using the BREAST-Q questionnaire.

[RESULTS] Mean grafted volumes were 210 cc intramuscularly and 115 cc subcutaneously per breast. No intraoperative complications occurred. Minor delayed healing (8.3%) and small oil cysts (8.3%) were managed conservatively. No cases of infection, fat necrosis requiring surgery, or major complications were observed. At 12 months, 83% of patients reported high satisfaction (BREAST-Q ≥ 80), with the remainder reporting moderate satisfaction; no patient regretted avoiding implants. Stable upper pole fullness was achieved, though without measurable elevation of the upper breast border.

[CONCLUSION] Layered lipofilling during mastopexy provides a safe and effective implant-free alternative, combining intramuscular stability with subcutaneous refinement. This approach achieves natural breast reshaping, high satisfaction, and low morbidity, though long-term durability beyond one year requires further study.

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