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BACKGROUND: Augmentation mastopexy has a 20-fold higher complication rate than primary augmentation. Performing augmentation mastopexy in post-bariatric patients poses an additional challenge owing to the reduced quality of the soft skin tissue. Therefore, it is technically complex and also fraught with complications. Implant dislocation, recurrent ptosis, wound healing problems with exposed implants, and the threat of implant loss are complications that must be prevented. METHODS: We present a case series study on our technique for stabilizing breast implants using the double inner bra technique (DIB) in which a laterobasal myofascial flap and an inferiorly based dermoglandular flap form a double inner bra for implant stabilization and protection. RESULTS: Thirty-seven cases were operated on using this technique from December 2020 to June 2023. No hematomas (0%), seromas (0%), infections (0%), and implant losses (0%) were recorded. Moreover, none of the patients had implant malposition (0%). With regard to recurrent ptosis mammae or waterfall deformity, 7 cases (2.6%) showed early ptosis within the first 3 months, and the number of ptosis decreased over time. Furthermore, 5 (1.81%) patients showed ptosis mammae after 6-12 months. Implant defect or rupture has not yet occurred (0%). CONCLUSION: The DIB is an easy-to-learn and versatile technique. It has low complication rates and can be used to achieve esthetically satisfactory mid- to long-term results.

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BACKGROUND: Augmentation mastopexy remains a challenging procedure. The goal is to achieve correction of breast ptosis whilst adding implant volume, and avoid complications of premature waterfall deformity, bottoming out and further revision surgery, particularly when using smooth implants. We aim to describe and evaluate a technique to reduce implant malposition in augmentation mastopexy. METHODS: This is a technical description and retrospective review of a single surgeons' cases from 2019 to 2022 of all patients who underwent 1 stage subpectoral breast augmentation mastopexy with the inferolateral pectoralis sling. RESULTS: Over the four year period, 284 patients (568 breasts) underwent augmentation mastopexy with the inferior pectoralis sling. Mean implant size was 360.7cc (range 180-625cc). There were no early complications and 6 (2.1%) patients had late minor complications, with five (1.8%) undergoing revision mastopexy with implant repositioning and 1 (0.4%) undergoing areola scar revision. 20 patients (7%) underwent an implant upsize procedure with the average volume increase being 218.5cc and the average time to upsize 13.6 months (range 6-36 months) CONCLUSIONS: Use of the inferolateral pectoralis muscle sling allows successful one stage augmentation mastopexy with low complication and revision rates. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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BACKGROUND: The inframammary fold (IMF) is an important landmark in breast aesthetic surgery. In augmentation mastopexy procedures, secure and accurate placement of the IMF is essential to aesthetic outcomes and to allow the new IMF to heal in the correct position without displacement. The authors present a simple and efficient four-layer wound closure technique using barbed sutures for closure of the repositioned IMF in augmentation mastopexy procedures. This method was previously described by the first author for reset of the IMF in breast augmentation surgery and has been adapted to the longer IMF incision in augmentation mastopexy procedures. METHODS: A retrospective review was undertaken of 335 patients who underwent bilateral breast augmentation mastopexy procedures with a Wise pattern technique at a single unit. The newly reset IMF was closed using barbed sutures and a four-layer closure technique. RESULTS: There were no cases of complications related to wound healing or wound dehiscence. One patient required explantation for an infected implant. CONCLUSION: The four-layer wound closure technique with barbed sutures provides a quick and efficient method for accurate closure of the newly reset IMF, with positive outcomes related to wound healing. Secure and accurate placement of the inframammary fold is crucial in augmentation mastopexy procedures. The use of a four-layer wound closure technique with barbed sutures provides an efficient method for accurate closure of the newly reset inframammary fold. This method was previously described by the first author for reset of the IMF in breast augmentation surgery and has been adapted to the longer IMF incision in augmentation mastopexy procedures. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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BACKGROUND: The goals of mastopexy differ significantly from those of augmentation mammoplasty. Mastopexy is designed to lift and reshape the breasts, while augmentation mammoplasty is designed to increase the volume of the breasts. This conflict causes that one-stage augmentation mastopexies showed a revision rate from 8.7 to 23.2%. The aim of our study is to present some technical refinements for reducing the risk of implant exposure and reoperation. METHODS: We designed a retrospective matched cohort study, including 216 consecutive patients, undergone augmentation mastopexy between January 2013 and December 2022. We divided them in two groups: Group A undergone an inverted-T superomedial pedicled augmentation mastopexy and Group B undergone our inverted-T modified augmentation mastopexy. The groups were matched for clinical and surgical variables, with the surgical technique the only difference between the two. RESULTS: Complications were registered in ten patients (9.3%) in Group A (two wound breakdowns at T with implant exposure and eight wound dehiscences), six of which required surgical revision. In contrast, only three patients (2.8%) in Group B reported a complication, which was wound dehiscence without implant exposure in all cases. None of the dehiscence required surgical revision. The difference between complication and revision rates was statistically significant. CONCLUSIONS: Separating the implant and the mastopexy dissection planes reduces the implant exposure and the reoperation rate in one-stage augmentation mastopexy. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .

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BACKGROUND: Over the latest 15 years, breast augmentation with implant has been progressively refined technically and artistically. However, little attention is usually given to the intermammary space. The aim of this article is to report author's experience and technique in the safe reduction of the intermammary space in breast augmentation with implants without fat grafting. PATIENTS AND METHODS: From July 2019 to July 2021, 62 consecutive patients undergoing cosmetic breast enhancement with implant and requesting a reduction of the intermammary space were retrospectively evaluated. Preoperatively, breast features were registered for all patients. Preoperative intermammary distance ranged from 2.3 to 7 cm (5.4 ± 0.74). RESULTS: The average follow-up time was 20 months (range 12 to 36 months). All implants were anatomical silicon-gel filled implants with micropolyurethane foam shell. No major early and late complications were experienced. The outcomes were graded as excellent in 45 breasts (72.6 %), very good in 15 (24.2%), good in the two cases (3.2%) with minor delayed wound healing (less than 1 cm) which solved conservatively within 1 month. Patients' satisfaction was high to very high. Postoperative intermammary distance was reduced in all cases and ranged from 1 to 4.5 (mean 2.6 ± 0.52 cm) CONCLUSION: The intermammary distance can be safely reduced with implant only in all cases who seek it, both via submuscular and via subfascial approach by a precise medial pocket dissection and implantation of micropolyurethane foam-coated implant, which guarantee device's stability during the healing process avoiding malposition. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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As individual procedures breast augmentation and mastopexy are relatively simple and low-risk procedures. Simply, breast augmentation comprises of placing an implant under breast tissue or a combination or breast tissue and muscle (Spear and Giese in Aesth Surg J 20(2):155-164, 2020. https://doi.org/10.1067/maj.2000.106474 ). Mastopexy involves reshaping the breast and commonly raising the nipple1. Complications in the individual procedures are relatively low and generally reported as capsular contracture in breast augmentation or minor wound break down in mastopexy (Spear and Giese 2020). When combined as an augmentation mastopexy everything changes. Augmentation mastopexy is one of the most difficult challenges faced in plastic surgery2. We describe an easy-to-follow algorithm to assist the surgeon in their operative decision-making. LEVEL OF EVIDENCE V: This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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BACKGROUND: Reoperative augmentation mammoplasty (RAM) is a challenging procedure, with the highest rates of complications and revision. Complications include implant malposition, lateral displacement, bottoming out, and rotation. These deformities can be addressed with various procedures, but the pocket control and stability of the new smooth implant surface may present limitations. OBJECTIVES: This study revisits a previously described predictable approach in primary breast augmentation and defines a surgical treatment algorithm for RAM technique selection. METHODS: Between 2017 and 2021, 72 patients (144 breasts) underwent RAM with composite reverse inferior muscle sling (CRIMS) technique and its technical variations (types I-IV). CRIMS technique involves placing a silicone gel implant into the submuscular (SM) pocket with an inferior sling of the pectoralis major muscle based on the dimensions of the implant, in combination with support points/dermal bridge sutures to stabilize the implant and glandular tissue at the lower breast pole (LBP). Reasons for surgery were ptosis (92%), implant and malposition (59.6%). Patients were followed for at least 6 months in 5 cases (6.9%), at least 12 months in 50 cases (69.4%), for at least 36 months in 10 cases (13.8%), and more than 36 months in 7 cases (9.7%) (mean 34 months; range 6-48 months). Patients were evaluated in terms of resolution of symptoms, satisfaction, and complications. Three-dimensional imaging (3DI) obtained from the Divina scanner system was used and followed up for 1 year to evaluate breast position, lower pole stretch (LPS), and intermammary distance (IMD). RESULTS: Eleven cases of minor complications were observed in 9 patients (12.5%): hypertrophic scarring in 4 (5.5%), wound dehiscence in 4 (5.5%), Baker II/III capsular contracture in 1 (1.3%). SmoothSilk surface silicone implants were used in all cases, with an average volume decrease of 120 cc. Sixty-eight patients (94.4%) were either very satisfied/satisfied with their aesthetic result. Breast images were performed in a group of 65 patients (90.2%), and in 7 breasts (10.7%), localized oil cysts were observed. The value for LPS was 7.87% (p <0.0001) between 10 days and 1 year, with the majority occurring early in the first 3 months, indicating that the LBP/implant remains steady during the last months of follow-up. No cases of fat necrosis/seroma were observed. There were no signs of intra/extracapsular ruptures, capsular contracture. There were 2 cases (3%) of minimal implant displacement and no cases of rotation. CONCLUSIONS: CRIMS and its variations can be performed successfully in RAM. An algorithmic approach can facilitate the pre- and intraoperative decision-making process and provide the new pocket control and implant stability with acceptable complication rates. Further accurate evaluation is recommended to understand the benefits or disadvantages of CRIMS compared to other RAM techniques. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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BACKGROUND: Single-stage mastopexy with augmentation is a commonly performed procedure. The single-stage procedure can be performed in primary cases or a secondary procedure in patients with previous history of augmentation, mastopexy or mastopexy with augmentation. The procedure is challenging and not without its risks. METHODS: A retrospective chart review of all consecutive cases of layered mastopexy with augmentation mammoplasties, carried out from September 2015 to August 2019, was performed. All patients had their implants placed in muscle splitting pocket first and access for the pocket was closed prior to the commencement of mastopexy. RESULTS: During the period of 4 years, 102 consecutive layered mastopexy with augmentations were performed in muscle splitting plane. Of these 102 patients, 74 (72.5%) patients had it as a primary and 28 (27.5%) as a secondary procedure. Of these 102 patients, 53 (52.0%) had textured, 37 (36.3%) had smooth and 12 (11.8%) had microtextured implants and 72 (70.6%) patients had high profile and 30 (29.4%) had medium profile implants. Same size implant was used in 89 patients with a mean of 298 cc, and 13 patients had different size implants with a mean of 362 cc on the right and 395 cc on the left. In current study, bilateral periareolar, vertical scar cat's tail and Wise pattern mastopexies were performed in 11, 51 and 27 patients, respectively. Of the 102 patients, 5 had unilateral right periareolar, 5 unilateral right vertical scar cat's tail, 2 unilateral left periareolar and 1 patient had a combination of periareolar and vertical scar combination. There was no nipple loss or periprosthetic infection. There was a minor wound breakdown seen in 4 (3.9%), haematoma in 2 (2.1%), nipple sensation loss in 2 (2.1%) and 12 (11.8%) had layered mastopexy as a part of a combined procedure. Revision was performed in 6 (6.5%), drains were used in 14 (13.7%), and 92 (90.2%) had the procedure performed as a day case. CONCLUSION: Layered mastopexy with augmentation is a safe procedure with added stability and safety to lower pole of the breast as well as nipple-areolar complex. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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Acellular dermal matrices (ADMs) have ushered in a paradigm shift in prosthetic breast reconstruction; however, there has hitherto been no reported use of Braxon® ADM in aesthetic breast surgery. Here, we describe the case of a 42-year-old woman who presented for revision of her bilateral aesthetic augmentation-mastopexy following multiple revision surgeries. The predominant concerns were persistent pain, implant malposition and a wide intermammary distance. Her predicament was worsened by inability to tolerate monopolar diathermy owing to a spinal stimulator-the least invasive operation was sought and Braxon® ADM met this criterion. The procedure was a success, and she remains symptom-free, with soft breasts and stable implant positions. Braxon® ADM, with its preformed shape, total implant-wrapping design and easy suture fixation, lends itself to easy use in cosmetic breast surgery. Its role in cosmetic breast surgery has yet to be established, but this case marks the beginning of this endeavor.

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Purpose of this article is to demonstrate a way of avoiding the waterfall deformity in augmentation mastopexy patients. We will show a case series of results and explain how this technique gives satisfying aesthetic results for patients seeking breast augmentation who also require mastopexy. We will show how addressing the breast parenchyma on the lower pole via direct excision can give reliable results and avoids the waterfall deformity. The surgical technique used by the senior author combines the principles of breast augmentation, mastopexy, and breast reduction. We apply these principles during the initial single operation. Our goal is to achieve the best anatomical results for the patient. We describe 1538 consecutive patients whom underwent single-stage breast augmentation with mastopexy. All implants were submuscular with 12% being saline and 88% were silicone implants. Vertical mastopexies were performed in 8% and wise pattern incisions were used in 92%. There were no life-threatening complications such as deep vein thrombosis, pulmonary embolism, and so on. Tissue-related complications included wound infection (1%) and hematomas (1%). Implant-related complications included malposition or implant displacement 9% and capsular contracture 1%. Aesthetic complications included dystopia of NAC (4%) and volume asymmetries (10%). Revision surgery was tissue related (2%), implant related (3%), and aesthetic related (10%). There were no cases of waterfall deformity seen in the cohort. In conclusion, we believe that the technique detailed here is easy to do, uses principles already known of breast augmentation and reduction and gives consistent results with low reoperation rates.

Le présent article vise à établir un moyen d'éviter les malformations en cascades chez les patientes ayant subi une mastopexie d'augmentation. Les auteurs présentent une série de cas et expliquent en quoi leur technique donne des résultats esthétiques satisfaisants pour les patientes qui veulent une augmentation mammaire et ont également besoin d'une mastopexie. Ils démontrent en quoi le traitement d'un parenchyme mammaire du pôle inférieur par excision directe peut donner des résultats fiables et éviter une malformation en cascades. La technique chirurgicale utilisée par l'auteur principal combine les principes d'augmentation mammaire, de mastopexie et de réduction mammaire. Les auteurs appliquent ces principes pendant l'opération initiale unique. Ils avaient l'objectif de réaliser les meilleurs résultats anatomiques pour les patients. Les auteurs ont décrit 1 538 patients consécutifs qui avaient subi une augmentation mammaire en une étape accompagnée d'une mastopexie. Tous les implants étaient sous-musculaires, 12 % étaient remplis de solution saline et 88 % étaient en silicone. Des mastopexies verticales ont été effectuées dans 8 % des cas, et des incisions en motifs prudents, dans 92 % des cas. Il n'y a pas eu de complications au potentiel mortel comme des thromboses veineuses profondes, des embolies pulmonaires, etc. Les complications tissulaires incluaient les infections des plaies (1 %) et les hématomes (1 %). Les complications liées aux implants incluaient une malposition ou un déplacement des implants dans 9 % des cas, et une contracture capsulaire dans 1% des cas. Les complications esthétiques incluaient la dystopie N-acétylcystéine (4 %) et l'asymétrie des volumes (10 %). Les opérations de révision étaient liées aux tissus (2 %), aux implants (3 %) et aux anesthésiques (10 %). Il n'y a pas eu de malformation en cascades dans la cohorte. Pour terminer, les auteurs sont d'avis que la technique est facile à effectuer, fait appel à des principes d'augmentation et de réduction mammaires déjà connus et donne des résultats uniformes liés à un faible taux de réopération.

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BACKGROUND: Hematoma after non-oncologic breast surgery is a common concern requiring expeditious treatment. The purpose of this study is to perform an evidence-based review of perioperative factors that may contribute to hematoma in non-oncologic breast procedures. METHODS: A comprehensive literature review was performed of non-oncologic breast procedures: breast augmentation, single-stage augmentation-mastopexy, mastopexy, and reduction. In total, 28 studies highlighting incidence and potential risk factors for hematoma were included; overall level of evidence was established regarding each perioperative factor examined and hematoma rate. RESULTS: The hematoma rate in breast augmentation ranges from 0.2 to 5.7%. There is inconclusive evidence to support an association between pocket choice or incision location and hematoma rate (Level III) and no evidence of an association between implant type and hematoma (Level V). Single-stage augmentation-mastopexy may have a lower hematoma rate than augmentation alone (Level II). Hematoma may increase the risk of capsular contracture (Level III). In breast reduction, the hematoma rate ranges from 1.0 to 9.3%. Evidence of an association between incision choice and hematoma rate is inconclusive (Level III). Use of epinephrine-containing solution, pedicle choice, and resection weight do not appear to affect hematoma rate (Level V, II, and II, respectively). The use of postoperative drains and ketorolac do not affect the incidence of hematoma (Level I and III, respectively). Intraoperative hypotension may increase the risk of hematoma after breast reduction (Level III). CONCLUSIONS: Breast hematomas are not uncommon complications. Current literature lacks ample evidence for risk factors for hematoma after non-oncologic breast procedures, warranting further, high-powered investigations. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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BACKGROUND: Recent history shows incomplete understanding of the long-term interaction between breast implants and biological tissues. Although complications of silicone-textured implants have been previously reported, conclusive data are still controversial due to the lack of reduced bias, long-term, comparative studies. We present our preliminary outcomes of 3 years aesthetic use of POLYTECH silicone POLYtxtⓇ and MESMO SensitiveⓇ implants. METHODS: This article is a retrospective analysis of 621 patients who have undergone primary aesthetic breast surgery (breast augmentation (BA) or augmentation mastopexy). The surgeries were performed by a single surgeon using Polytech microtextured silicone implants (POLYtxt and MESMO). Complications, with main focus on late seroma, were assessed and compared based on texturization type. RESULTS: From January 2015 to September 2018, 358 patients were treated with POLYtxt and 263 with MESMO-textured implants. Incidence of complications, such as hematoma, infection, early seroma, capsular contraction and malposition/rotation was comparable between the two groups. Incidence of late seroma was, respectively, 6.4% (POLYtxt) and 0% (MESMO) resulting in a statistically significant difference between the two groups. Overall complications and reinterventions were 12.5%-9.2% (POLYtxt) and 4.5%-3.8% (MESMO), respectively, showing a significantly lower occurrence in the MESMO group. CONCLUSIONS: This reduced bias study shows an increased risk in overall complications and reoperations with POLYtxt surface implants compared with MESMO. Furthermore, we registered an exceptionally high rate of late seroma when the more "aggressive" POLYtxt texturization was used. Conversely, a significantly low incidence of adverse events was registered with the MESMO surface, which has turned this device in our first choice in daily practice.

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INTRODUCTION: Wounds are generally classified as clean, clean contaminated, contaminated and dirty. Aesthetic surgery, including breast augmentation, is classified as clean or clean contaminated. The presence of bacteria on the skin, in nipple secretions, in superficial and deep parenchymal samples and also the presence of bacteria in capsules and on implants justifies the use of antibiotics. However, there is a paucity of information about whether added bacterial flora on the capsule of the implant pockets, and the handling of these capsules as capsulotomy or capsulectomy makes secondary augmentation mammoplasty more prone to wound healing issues or periprosthetic infection. The current study is the analysis carried out between primary and secondary augmentation mammoplasties to look at the incidence of periprosthetic infection between the two groups. MATERIAL AND METHODS: A retrospective data analysis for periprosthetic infection and wound healing issues following primary and secondary augmentation mammoplasties performed between April 1999 and April 2019 was carried out. RESULTS: A total of 2521 (5042 breasts) primary and 386 (772 breasts) secondary augmentation mammoplasty data were available for analysis. Periprosthetic infection was seen in 0.7% and 0.5% of the primary and secondary augmentations, respectively, with no significant difference. Wound healing issues were significantly higher in primary augmentation mammoplasty. CONCLUSION: There was a marginally higher incidence of periprosthetic infection in primary augmentation mammoplasty as compared to secondary augmentation mammoplasty; however, the difference was not significant. On the contrary, the wound healing and superficial skin issues were higher in primary as compared to secondary augmentation mammoplasty, and the difference was statistically significant. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online instructions to Authors www.springer.com/00266 .

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BACKGROUND: Type I tuberous breast deformity (according to Grolleau's classification) is characterized by the hypoplasia of the lower medial quadrant of the mammary gland and ptosis of the lower lateral quadrant. This results in an aesthetic imbalance in the breast that has an unnatural and unattractive appearance. The study aims to propose a surgical technique ensuring the successful correction of hypoplasia of the lower medial gland quadrant combined with ptosis. The essence of the technique is augmentation mastopexy with circumlateral vertical access. In the presence of pronounced ptosis of the breast, it is combined with the horizontal component and rotation of the gland flap. METHODS: The participants in the study were 26 patients (51 breasts) who were treated for type I tuberous breast deformity from 2015 to 2020. The average age of the patients was 34 years (within the range of 27-42 years). Patients from Group I were treated using the technique of circumlateral vertical mastopexy, and patients from Group II using circumlateral vertical augmentation mastopexy with a horizontal component. RESULTS: The average follow-up period was 36 months (9-60 months). Treatment was aimed to correct tuberous breast deformations of type I (according to Grolleau) combined with varying degrees of ptosis. The complication rate for all patients in this study was 5.4%-1 patient (1.8%) had a hematoma, 1 (1.8%) had postoperative implant malposition, and 1 (1.8%) had visibility and palpability of the implant edges. CONCLUSIONS: Circumlateral vertical access can be applied for augmentation mastopexy in patients who wish to simultaneously correct ptosis and type I tuberous breast deformity and perform breast augmentation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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BACKGROUND: Nipple hypertrophy is a rare aesthetic problem. Ideal nipple dimensions are 6-8 mm, while nipples larger than 10 mm are considered hypertrophic. PATIENTS AND METHODS: A total of 24 female patients, aged between 22 and 53 years, with a nipple diameter or height greater than 10 mm, underwent augmentation mammoplasty (AM), augmentation mastopexy (AUM) and reduction mammoplasty (RM) operations. The patients were divided into three groups according to the type of surgery containing equal numbers of patients. Group I underwent AM, Group II underwent AUM and Group III underwent RM surgery. Preoperative and 1-year post-operative nipple dimension measurements were performed, and the results were compared. RESULTS: There was no significant difference between the preoperative nipple volumes among the groups (p > 0.05). There was no significant difference between preoperative and post-operative nipple volumes in Group I (p > 0.05). The difference between preoperative and post-operative nipple volumes in Group II and Group III was significant (p < 0.05). When post-operative dimension comparisons were taken into consideration, there was a significant difference between Group I compared to Group II and Group III (p < 0.05); however, the difference between Group II and Group III was not significant (p > 0.05). CONCLUSIONS: Since there will be no reduction in nipple size during the post-operative period in AM patients, hypertrophic nipple can be reduced in the same session. However, in patients with AUM or RM, if the reduction in nipple size is not sufficient, it is more convenient to perform the nipple reduction operation 1-year post-surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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Simultaneous breast augmentation and mastopexy is very challenging often considered to be one of the most difficult cosmetic breast surgeries. Although a patient is sometimes better served with 2 separately staged procedures, the demand for single-stage combined augmentation mastopexy is increasing associated with increasing demands for larger implants. Combining these 2 operations presents special problems because of the interplay of opposing forces. To avoid bottoming out, wound dehiscence, and ultimately implant extrusion, it is essential to provide proper coverage and support of the inferior breast pole. The goal of this report is to illustrate the benefit of an inferiorly based fascioglandular flap in providing adequate breast lower pole support in simultaneous breast augmentation mastopexy. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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BACKGROUND: Numerous methods have been designed to reduce breasts size and weight. The goal today is to not only to reduce size but also to create a pleasing shape. Breast reduction techniques do not obtain the desired upper pole fullness, and commonly recurrent ptosis develops. To improve and maintain breast shape in the late postoperative period, we combine breast reduction with implants. METHODS: Three hundred and sixty-six patients who underwent combined breast reduction or mastopexy with implants from January 2014 to November 2017 at IM Clinic were retrospectively reviewed. We present the indications, surgical technique, and outcomes of these patients to determine the safety and efficacy of our technique. RESULTS: No major complications were noted in an average of 2 years of follow-up (range 2 months to 4 years). Minor complications occurred in 61 patients, of whom 46 required revision surgery (12.6%). The most common tissue-related complications were dog ears (7.6%) and poor scarring (4.9%). The most common implant-related complication was capsular contracture (0.8%). CONCLUSIONS: Breast reduction with implants is a reliable option to provide additional volume to the upper pole of the breast to improve long-term breast shape and avoid ptosis recurrence. Our study indicates that the procedure is safe and has complication and revision rates comparable to traditional breast reduction or augmentation mastopexy techniques. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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BACKGROUND: Simultaneous augmentation-mastopexy is a particularly tricky operation with a considerable reoperation rate. The pectoralis muscle sling has proven to be a suitable alternative technique for long-term results in breast parenchyma suspension without silicone implants. This study aims to propose a promising approach to simultaneous augmentation-mastopexy revisional surgery using an inverted dual-plane technique acting as a muscular sling. METHODS: A 10-year historic cohort was conducted to obtain the following variables from our preexisting database: age, preoperative measurements, operative technicalities, implant details, time from procedure to revision, complications, and outcomes. RESULTS: Twenty-six patients assessed after the initial postoperative year were analyzed. Review of this series of patients revealed a revision rate of 3.8% and overall rate of morbidity of 11.5%. CONCLUSION: Simultaneous augmentation-mastopexy using an inverted dual-plane technique acting as a muscular sling is a reliable and safe procedure. Review of this series of patients revealed low rates of morbidity and reoperation need. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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INTRODUCTION: Several factors, such as aging, pregnancy, and weight loss, reduce the elasticity of the breast tissue, and ptosis occurs. Due to aging and gravity, it is not possible to completely prevent breast ptosis. The goal is to delay the recurrence of ptosis as much as possible. PATIENTS AND METHODS: This study included 20 female patients aged 25-55 years. The patients who underwent surgery had different levels of ptosis. Although the patients wanted their breasts to be lifted and an increase in projection, they did not want implants to be used. For this reason, autologous flaps were prepared from the patients, and these flaps were called autoprosthesis flaps. The flap donor area (FA) boundaries consisted of the inframammary fold at the bottom, the medial and lateral pillar legs at the two sides and the lower margin of the areola at the top. The skin on the FA was de-epithelialized. A hand dermatome was used to ensure that the extracted skin was not too thick because the rest of the dermal skin would form the cover of the planned autoprosthesis flap. Before surgery, the autoprosthesis flap baseline width, projection, and shape (round or anatomic) were planned for each patient. The autoprosthesis flap was prepared as a central pedicle, and the dermal layer, which was 1 cm wider than the flap, was then attached over the autoprosthesis flap to the pectoral muscle fascia with at least 10 sutures in the recipient area. For a round autoprosthesis flap, the flap base diameter was 10-12 cm on average, whereas for an anatomic autoprosthesis flap, the width of the flap was 10-12 cm and the height was 12-14 cm. Autoprosthesis flap projections varied from 4 to 6 cm. RESULTS: Because of the autoprosthesis flap, breast projection was more prominent, even in the lying position. All the patients were very satisfied with their size, shape, projection, and natural appearance. In particular, the image in the lying position was very similar to a mastopexy performed with an actual breast implant; thus, sagging was not observed. CONCLUSION: In augmentation mastopexy patients who do not want implants, upper pole filling and adequate breast projection can be easily achieved with this method. The potential risks of capsule formation, implant rejection, and implant rupture were not observed with this technique. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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PURPOSE: Breast augmentation combined with mastopexy is associated with a significantly higher complication rate than augmentation alone. The combination of mastopexy and breast implants has revealed a moderate recurrence of breast ptosis in many patients particularly with use of medium to large implants. Ptosis is the "bottoming out" of the breast tissue with loss of the desired roundness, due to the ptosis of the breast implant and the mammary tissue. In this study, we hypothesize the need for careful planning and careful preoperative surgical execution to minimize this complication. PATIENTS AND METHODS: Between January 2007 and July 2011, augmentation mastopexy with implant and autologous tissue ("double implant") was performed for 25 patients with grade III mammary ptosis. All patients underwent inverted-T mastopexy with supramuscular moderately cohesive gel breast implant using an inferior-based flap of de-epitelialized dermoglandular tissue and a superior-based nipple-areola complex pedicle. RESULTS: An inferior-based flap of deepithelialized dermoglandular tissue was used to stabilize the implant and is projection. Breast lifting was performed through a strong anchorage to fascia and to muscle of second intercostal space, improving the profile of the breast. Results were analyzed, no breast ptosis recurrence was noted at 30-month follow-up. CONCLUSIONS: Our technique presents the challenge of determining the amount of excess skin to be removed after implantation to create symmetry and provide for skin tightening without compromising tissue vascularization.

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