Augmentation mastopexy: to stage or not

Dr. Nahai: The first patient is a woman in her mid 30s (Figure 1). She has 2 children and wants her breasts to be larger and lifted. The thickness of her breasts in the upper inner quadrant measures 2 cm. Dr. Fisher, how would you help this woman achieve her goals?Figure 1 This woman, in her mid 30s, has had 2 children. She would like her breasts lifted and enlarged.Foad Nahai, MDDr. Fisher: The first issue would be to find out what size she wants to be. One rule of thumb is that the larger the implant, the less lift is required. If you look at her side view, her nipple is almost at her inframammary fold. I think she has adequate tissue for me to consider subglandular placement of gel implants, using a periareolar incision. Once the implant is inserted, I could determine the amount of skin to excise in the periareolar area.Jack Fisher, MDDr. Nahai: You would be comfortable using the gel implant with a thickness of 2 cm in the upper inner quadrant?Dr. Fisher: Yes.Dr. Nahai: You feel that, because of nipple position, the augmentation alone might correct her ptosis. But if not, would you then alter the skin envelope?Dr. Fisher: Exactly.Dr. Nahai: Dr. Maxwell, how would you approach treating this patient?Dr. Maxwell: I agree to a certain extent with Dr. Fisher, but this patient has a little too much ptosis for me to anticipate correction with an implant only. I would plan a periareolar approach augmentation mastopexy, incorporating an appropriate purse-string suture. I would use a silicone gel implant of appropriate base width, and I would place it subfascially.Patrick G. Maxwell, MDI am more comfortable using the subfascial position. From my perspective it is a better …