Four-step Augmentation Mastopexy: Lift and Augmentation at Single Time (LAST)

Augmentation mastopexy is one of the most difficult challenges plastic surgeons face, especially concerning sustainability of upper pole fullness and lower pole ptosis correction. We describe our technique for augmentation mastopexy that provides inferolateral muscular support for the implant and standardizes a sequence of surgical stages to resolve multiple situations and present the outcomes of patients who underwent such an approach. METHODS: Our technique proposes the following: (a) modified subpectoral pocket, with muscular inferolateral support for the implant; (b) independent approaches to the submuscular (implant) pocket and parenchymal resection/reshaping; and (c) pre-established 4-step surgical sequence. Data from office files of our private practice were collected for 266 patients who underwent the technique from October 2015 to January 2019. Patient perception about esthetic outcomes, photographs from multiple postoperative follow-ups, and surgical complications/reoperation rates were analyzed. RESULTS: Overall mid-term and long-term results (39 months) were positive for lift and augmentation at single time mastopexy; >90% of patients reported satisfaction with their esthetic outcomes, including absence of ptosis. No major complications occurred. The total revision rate was 16%, but it became <5% in 2018 as the learning curve progressed. CONCLUSIONS: Augmentation mastopexy is complex, and the myriad of approaches and possibilities may cause confusion when selecting the most suitable one. The 4-step sequence provides a reliable option, offering a predefined execution plan, whereas inferolateral muscular support prevents recurrence of lower pole ptosis. Other surgeons’ experience with lift and augmentation at single time mastopexy and further studies are necessary to validate these findings.