The Three-Flap Technique: A Modification of Autoaugmentation Mastopexy in a Single-Surgeon Case Series

Abstract Background Implant-free mastopexy remains challenging in patients seeking breast reshaping without implants. Autoaugmentation techniques using autologous parenchymal flaps may improve breast projection and upper-pole contour. Objectives To describe the Three-Flap Technique as a modification of implant-free, caudally based parenchymal autoaugmentation mastopexy and to report clinical, anthropometric, and patient-reported outcomes in a selected single-surgeon case series. Methods This retrospective, single-center, single-surgeon consecutive case series included women with glandular, Grade I, or selected mild-to-moderate Grade II ptosis who underwent the Three-Flap Technique between January 2019 and December 2024. Outcomes included standardized photographic assessment, suprasternal notch–to–nipple and nipple–to–inframammary fold distances, complications, and BREAST-Q scores. Results In-person follow-up was available for 284 patients (97.0%) at 3 months, 235 (80.2%) at 6 months, 188 (64.1%) at 12 months, and 100 (34.1%) at 24 months. Breast contour instability, defined clinically as loss of upper-pole contour with lower-pole descent, was observed in 9 patients (3.1%). Delayed T-junction wound healing occurred in 31 patients (10.6%). No total nipple–areola complex necrosis occurred. In the paired BREAST-Q cohort (n = 109), Satisfaction with Breasts increased from 41.2 ± 12.5 to 86.7 ± 9.3, and Psychosocial Well-being increased from 54.5 ± 11.7 to 89.4 ± 7.8. Conclusions The Three-Flap Technique may represent an additional implant-free autoaugmentation mastopexy option for selected patients. Further comparative studies are required.