The Circumrotational Technique for Mastopexy.

Numerous combinations of pedicle design and incision patterns have been described for mastopexy, but upper pole volume deficiency, suboptimal shape, or recurrent ptosis are still undesired postoperative findings. The challenges of preventing such outcomes are amplified in the massive weight loss (MWL) patient population, where both the extent of morphologic deformation and alterations in tissue characteristics (ie, a materials failure) can be severe. To correct this problem, we propose a technique that combines breast circumference-reduction with maximal glandular rotation and superomedial repositioning: the circumrotational technique. The technique reduces the circumference of the breast base, enhances anterior projection, and defines the lateral breast border by maximal glandular rotation and elevation, reorienting and engaging lax structural elements within the parenchyma. It also recruits ptotic lateral breast tissue into the upper pole, maximizing volume. This technique proposes an initial glandular hyperelevation, upper pole tissue "stacking," and broad peripheral fixation of the breast-to-chest wall to support the breast during the healing period and combat the propensity for recurrence. The circumrotational technique has been mostly used for mastopexy after MWL, but can also be used for typical mastopexies in non-MWL patients with grade 2 or 3 breast ptosis.