A stacked technique of mastopexy: volume redistribution mastopexy with inferior flap and superomedially based pedicle.

BACKGROUND: Many mastopexy techniques focus on lifting the position of the nipple and excising the skin, with less attention paid to redistributing the uplifted volume of the ptotic breast. With the inferior pedicle technique, the onus is placed on skin taking the tension for the whole breast. Skin stretch then may lead to pseudoptosis.
METHODS: With the advent of breast suturing, breast volume can be reshaped and lifted with less reliance on skin tension to maintain the lifted breast position. Since 2006, the senior author (G.J.O.) has applied these breast suturing and oncoplastic breast reconstructive techniques to mastopexy. By creating more than one flap/pedicle of the breast tissue, breast parenchyma can be redistributed more successfully towards the upper pole. The authors make no claim to originating this principle, which has been used by many plastic surgeons over the years, but they wish to explain their version of the technique that has evolved over the last 6 years.
RESULTS: The authors present their arguments for this technique and discuss the relevance of improving upper-pole fullness and their concepts regarding skin re-draping.
CONCLUSION: The key tenet for successful mastopexy is volume redistribution. Excision of skin is the secondary consideration. A natural-appearing breast shape can be achieved 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 .