Combined augmentation mastoplexy [abstract]
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Background: First described by Gonzales-Ullo in 1960, combined augmentation/mastopexy has increased in popularity amongst patients interested in a single stage procedure that reduces cost and decreases recovery time. The controversy surrounding the combined technique stems from the fact that augmentation and mastopexy represent conflicting procedures: augmentation expands and stretches breast tissue while mastopexy reduces the size of the skin envelope. Although the combined procedure has been described, there are few large studies comparing a single surgeon's outcomes. Methods: We retrospectively reviewed the charts of 320 consecutive patients from 2000-2009 who underwent combined augmentation/mastopexy (113), augmentation (194), and mastopexy (13). Data was collected and compared among the three groups in terms of pre-operative risk factors and ptosis grade, operative technique, implant size, and post-operative complications. Results: The most common complications for the combined procedure were areolar widening (17.7%), hypertrophic scarring (8.8%), decreased nipple sensation (7.1%), implant malposition (6.2%), and hematoma formation (6.2%). The tissue related complications were similarly higher in the combined and mastopexy groups, but the implant related complications such as implant malposition, capsular contracture, and double bubble occurred less frequently in the combined group than with augmentation alone. Conclusion: Although it has often been suggested that a combined procedure carries a risk higher than performing augmentation and mastopexy individually, our results indicate that a combined procedure can produce excellent results with decreased implant related complications. Given the notable benefits of a combined procedure, we believe that that a single stage augmentation/mastopexy is the preferred technique for the experienced surgeon.