Auto-Augmentation Mastopexy: Adding Upper Pole Fullness During Mastopexy Surgery
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A major challenge with mastopexy procedures in some patients is creating sufficient upper pole fullness when the breasts are lifted. By ‘upper pole’ plastic surgeons are referring to the part of the breast above the nipple-areola complex, a portion of which may be visible in a swimsuit or cocktail dress.
Both the aging process and post-pregnancy breast atrophy may result in loss of upper pole volume. And we see many patients for mastopexy whose breast have always been somewhat droopy and who have never had upper pole breast fullness.
If upper pole volume is lacking preoperatively, it can be difficult to impossible to create significant upper pole fullness by means of a conventional mastopexy procedure alone. There are three possible means of creating upper pole volume during mastopexy for these patients:
- Placing breast implants at the time mastopexy surgery (referred to as ‘augmentation mastopexy’)
- Performing upper pole breast fat grafting at the time of mastopexy or afterwards
- Performing auto-augmentation mastopexy, where central lower pole breast tissue is moved to the upper pole to
Augmentation mastopexy
Overall breast volume can be enhanced by means of breast implant placement at the time of a mastopexy surgery, and this procedure is known as augmentation mastopexy. The implant provides additional needed breast volume, and the mastopexy (breast lift) procedure restores a more youthful breast shape and a more ideal position for the nipple-areola complex.
One potential issue with augmentation mastopexy is that breast implant placement makes the entire breast bigger, not just the upper pole. So if a patient is interested in selective enhancement of upper pole volume, but does not want the entire breast to be significantly bigger, then breast implant placement is not the best option.
Additionally, there are plenty of patients who, for any of a variety of reasons, are not interested in having breast implants placed. In these instances, one needs to find some other means of providing additional upper pole breast volume at the time of breast lift surgery.
Breast fat grafting following mastopexy
Fat grafting, using the abdomen, hips or thighs as fat donor sites, can be an effective means of adding upper pole volume to the lifted breast. There are several considerations to know about if this option is appealing to you.
Breast fat graft survival is generally about 50-60%. So if we add 100cc of fat to each breast upper pole, each upper pole will ultimately be about 50-60cc larger. In some cases, breast fat grafting may need to be repeated to achieve the desired outcome.
The most important consideration regarding upper pole fat grafting at the time of mastopexy is blood supply. In most modern mastopexy procedures, the blood supply to the nipple-areola complex is primarily (or solely) the upper pole. As you add fat to the upper poles you are increasing upper pole tissue pressure, and if tissue pressure goes high enough then blood flow may be restricted.
Fat grafting therefore has the potential to cause ischemia (lack of blood flow) at the nipple-areola complex, which can in turn lead to necrosis and skin / soft tissue loss. Because of this potential risk, in most cases I prefer to perform upper pole fat grafting a minimum of three months following mastopexy surgery. This gives the breast a chance to recover from mastopexy surgery and for circulation to become more robust at the nipple-areola complexes.
Auto-augmentation mastopexy
The “auto-augmentation” concept is to mobilize central lower pole breast tissue, that normally would be removed at the time of a breast lift surgery, and use that tissue to enhance upper pole volume. Central lower pole tissue below the nipple-areola complexes can be freed from surrounding tissue, but left attached to the chest wall so that there is still a blood supply for the lower pole tissue that has been mobilized.
Once the central lower pole auto-augmentation breast flap is mobile, a pocket is dissected behind the breast superficial to the pectoralis major muscle, as if one were creating a pocket for a submammary breast implant. The auto-augmentation flap is advanced into that pocket and is sutured to the pectoralis major muscle, securing the flap of tissue in the upper pole of the breast.
When the mastopexy procedure is completed, the upper poles have additional volume that has been created by transfer of the lower pole fap. In some patients there is enough lower pole tissue to create so much upper pole fullness that on the operating table it appears as though the patient might have breast implants in place.
Auto-augmentation mastopexy is a powerful procedure for using the patient’s own natural tissues to enhance upper pole volume. It has the significant advantage of augmenting the upper pole only, and does not add volume or weight to the lower pole of the breasts (as an implant would do), which may stretch out the lower pole over time.
It is important to understand that not everyone is a candidate for this procedure. To effectively enhance upper pole volume one must have sufficient lower pole tissue for transfer to the upper poles. If there is not enough central lower pole tissue to create an auto-augmentation flap of adequate volume, then the best ‘no-implant’ upper pole enhancement technique is breast fat grafting – which may need to be performed as one or possibly a series of two procedures after recovery from mastopexy surgery.
If you are interested in breast lift surgery and you also are certain that you do not want to have breast implants placed as well, auto-augmentation mastopexy is an excellent means of providing additional upper pole breast fullness. In many patients this procedure can help to create the most aesthetically ideal breast profile postoperatively. Ask your board certified plastic surgeon about auto-augmentation mastopexy surgery, and whether or not it is an appropriate option for you.