Secondary mastopexy in the augmented patient: A recipe for disaster

Background: Augmentation mammaplasty is popular procedure, but one that is associated with a relatively high rate of revisionary surgery. Over time, the augmented breast frequently becomes ptotic and patients may return requesting mastopexy. Experience has shown that secondary mastopexy in the augmented breast is fraught with potential complications, including fat necrosis, skin flap loss, and nipple ischemia. Methods: Factors that contribute to increased morbidity when mastopexy is performed in the previously augmented breast are analyzed; the surgical options available for correcting ptosis in these cases are systematically reviewed. Results: The long-term presence of implants typically results in changes in breast anatomy and physiology, including parenchymal atrophy, tissue thinning, and diminished skin blood supply. These factors greatly increase the surgical risks of secondary mastopexy. Conclusions: When planning and executing mastopexy in the previously augmented patient, the plastic surgeon must carefully consider the potential adverse effect of implants on the blood supply to the breast. With thoughtful planning and cautious operative technique, good results can be achieved in most cases, and the risk of serious complications can be minimized.