Discussion: prospective comparative clinical evaluation of 784 consecutive cases of breast augmentation and vertical mammaplasty, performed individually and in combination.

BACKGROUND Despite the growing popularity of breast lift surgery, no published study prospectively evaluates mastopexy and augmentation/mastopexy. Several investigators suggest an inordinate risk in combining augmentation and mastopexy, and recommend staging the surgery in some patients. However, no existing study includes the necessary individual and combined treatment cohorts to allow reliable comparisons of safety and efficacy. This study investigates the clinical outcomes and safety of these cosmetic breast procedures, whether performed individually or in combination. METHODS This 10-year prospective study evaluated 759 consecutive women undergoing 784 consecutive cases of breast augmentation (n = 522), mastopexy (n = 57), augmentation/mastopexy (n = 146), reduction (n = 48), and reduction plus implants (n = 11). All patients were treated by the author using submuscular implant placement and vertical parenchymal resection with a medial pedicle and intraoperative determination of nipple positioning. A power analysis confirmed adequacy of the sample sizes. RESULTS The complication rate was 36.3 percent for augmentation/mastopexy, 33.3 percent for mastopexy alone, and 17.6 percent for breast augmentation alone. Mammaplasties were complicated by persistent ptosis in 9.5 percent of patients. The revision rate after augmentation/mastopexy was 20.5 percent, compared with 24.6 percent for mastopexy and 10.7 percent for breast augmentation. CONCLUSIONS Vertical mammaplasty may be used to correct ptosis in breasts of all sizes. Vertical augmentation/mastopexy provides complication and revision rates that are less than the calculated cumulative rates for the procedures performed separately. The combined procedure offers technical advantages and permits safe single-stage surgery using the vertical technique. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.