Simultaneous breast augmentation and mastopexy.

The results of combining breast augmentation and mastopexy are less predictable than those associated with mastopexy or augmentation mammoplasty alone. A method of breast skin envelope reduction is presented that allows the surgeon performing mastopexy to preview the final breast shape before committing to skin resection. This method, first described in 1978, has proven to be technically versatile and reproducible, and applicable not only to moderate (second degree) and severe (third degree) ptosis but also to simultaneous breast augmentation and mastopexy. For the combined procedures, the practical strategy proposed is first the implant placement through a periareolar incision, and a vertical transglandular incision, usually submusculofascial; second, restoring the gland anatomy by closing the muscularis and the vertical transglandular incision; third, skin envelope adjustment using the Tailor-Tack maneuver to accurately assure the best position of the nipple-areolar complex on the breast mound; fourth, skin incision, de-epithelialization and undermining; and finally, closure combining the the Purse-String maneuver with the vertical incision.