Mastopexy with expansion-augmentation.

[BACKGROUND] Because the technique for mastopexiy with augmentation is difficult to perform and entails the risk of complications, some surgeons perform it as a 2-stage procedure.

[OBJECTIVE] A technique is described that takes advantage of the "minimal scar" from the vertical mastopexy and uses the Spectrum adjustable implant (Mentor Corp, Santa Barbara, CA) to minimize complications and improve the appearance of the breast after operation.

[METHODS] The keyhole skin in an area around the areola was deepithelialized. The skin was undermined, and a "tunnel" was created underneath the areola. The "skin-gland" bridge of inferior tissues was divided, and medial and lateral breast "columns" were created by undermining the gland. The fibers of the pectoralis major muscle were undermined to create a pocket for the implant. After the implant was placed and filled, the muscle incision was closed, and the previously created breast columns were excised and sutured together. The nipple-areolar complex (NAC) was sutured to the keyhole apex, and the base of the keyhole was closed around the base of the NAC pedicle. The reservoir was attached, and the remainder of the areola was closed. The implants were expanded, and excess fluid was released after several weeks.

[RESULTS] A series of 26 patients underwent the procedure between February 1998 and April 2001. Results of 3 representative cases are presented.

[CONCLUSIONS] Use of an implant adjustable after operation for a single-stage mastopexy with augmentation procedure enables the surgeon to avoid many of the complications inherent in simultaneous breast lift and augmentation.