A simple classification and a simplified treatment's algorithm for ptotic breasts

Aim: Many classifications have been described in the literature for ptotic breasts, focusing on the nipple areola complex position compared to the inframammary fold. These use centimeters and lateral views to illustrate their various grades in a manner always insufficient to propose a clear treatment plan aimed at achieving natural results. We discuss a new dynamic approach to breast ptosis with a complete treatment algorithm. Methods: Patients were examined in a standing position first with hands down then with hands up. We observed the elevation of the inter-nipple line called the “BK-line” and its relationship to a sternal benchmark that we call the "BKPoint". The "hands-up test" was positive when the line crossed the landmark. The algorithm defines the indication according to this clinical examination and to the patient's wishes. An angle between the nipple, the “BK-point” and the body meridian (called the “BK angle”) was appreciated before and after surgery. This angle should become 90° or more after ptosis treatment. Results: Three hundred patients were treated for ptotic breasts, including breast reductions, from January 2010 to September 2017. The definitions of “normal” non-ptotic and ptotic breast and the “ideal” breast were reconsidered. The surgical indications were adjusted to the clinical situation and to the patient's wishes, refining the final version of the algorithm. Conclusion: This new classification is easy, reproducible and efficient. We propose an appropriate algorithm to treat every situation that takes care to consider patient’s wishes and expectations.