Breast Suspension and Ligament Reconstruction Mammoplasty in 95 Consecutive Cases

BACKGROUND: Breast ptosis results from an involution of breast parenchyma with the underlying Coopers’ ligaments becoming stretched over time resulting in a complete loss of support to the breast mound. This loss in volume results in a decrease in upper pole fullness, an increase in the lower pole fullness and width, and in addition a loss of breast projection. Many techniques have been described to address the components of a youthful breast. Mastopexy presents many challenges including avoiding tissues from “bottoming out” with a boxy look, maintaining upper pole fullness, as well as ideally providing an “implant-like” look with a round, projected mound. The authors present their experience using a specialized technique to address the components of a ptotic breast. The procedure uses a superior medial pedicle for nipple transposition. This is combined with an inferior dermoglandular pedicle for auto-augmentation (Graff/Briggs flap), to improve the upper pole fullness and increase projection. In order to avoid the superior medial pedicle from bottom out, superior suture suspension of the superior medial flap to the pectoralis muscle fascia is utilized. Finally, the lower pole excess skin is deepithelized and superiorly based dermal grafts from the tissue that is routinely discarded is used to provide support to the breast mount medial and lateral pillars and avoid the superior medial flap from migrating. METHODS: Analysis of electronic records of patients who underwent breast suspension with ligament reconstruction between April 24th, 2012 and September 13th, 2023 were analyzed. A total of 95 consecutive cases were discovered. Photographic records were taken before and during follow-up clinic visits at 1 month, 3 months, 6-8 months and occasionally greater. RESULTS: Breast suspension with ligament reconstruction mammaplasty was successfully achieve in 95 consecutive patients. Average age was 40 years old (standard deviation 7 years, maximum: 54 years, minimum: 25 years). Average body mass index (BMI) was 30 (standard deviation: 4, maximum: 45, minimum: 21) Complications were as follows: Partial areola necrosis (N = 2, 2.1%), partial inferior dermoglandular distal tip necrosis (N = 4, 4.2%), and minor complications including small wound breakdown in the vertical limb closure (N = 6, 6.3%). No cases of bottom out deformity were recorded, but patients with poor quality of skin may eventually have a natural descent of the whole breast mound occur without ptosis. CONCLUSION: Breast suspension with ligament reconstruction mammaplasty offers a safe and reliable technique that improves patient surgical results. This technique is not indicated for all types of breasts. Nevertheless, it provides another option to the plastic surgeon armamentarium to address the challenges of mastopexies.