Expanded Approaches for Mastopexy in Aesthetic and Reconstructive Breast Surgery.

Learning objectives: After studying this article, the participant should be able to: (1) Understand the unique differences between mastopexy in aesthetic and reconstructive breast surgery. (2) Describe the approach to performing mastopexy with autoaugmentation or after explantation. (3) Have insight into the approach and decision-making process for performing mastopexy with nipple-sparing mastectomy. (4) Apply the mastopexy skin reduction techniques to ptotic women undergoing postmastectomy breast reconstruction.

Summary: Techniques and indications for mastopexy are expanding. In aesthetic surgery, access to supportive meshes and higher rates of breast implant explantation without replacement contribute to this. In breast reconstruction, higher rates of nipple-sparing mastectomy and higher expectations for cosmetically favorable outcomes with ptotic breasts are key drivers. A keen understanding of the available blood supply and how it may change over time with a staged approach, thoughtful use of otherwise-discarded tissues, and judicious application of mesh support are important new considerations for plastic surgeons to apply to traditional mastopexy. This evidence-based article focuses on specific aesthetic and reconstructive mastopexy techniques associated with autoaugmentation, explantation, and nipple-sparing mastectomy.