Background: Autologous mastopexy is an alternative for patients with small breasts, ptosis and upper pole hollowness, who desire improvement in their breast shape without using an implant. A variety of techniques have been tried throughout the years. Recently the use of autologous fat grafting (AFG) for breast augmentation increased in popularity and showed satisfying cosmetic outcome in enhancement of size, shape and texture of the breast. Methods: 25 patients with grade 2 ptosis were included in this study. Lower Island Flap Transposition (LIFT) technique was modified and either done alone or in combination with lipofilling, whether at the same setting or as a second stage. Preoperative and postoperative measurements and pictures were documented. Results: Lateral upper pole projection measurements showed an average increase of 28.5% equal to about 1.8 cm. As for the maximum breast projection an increase of about 33% accounting for about 2 cm was documented. Conclusions: This study shows that the combination of LIFT technique after its modification with AFG has proven to be an effective technique with consistent results for patients presenting with grade 2 ptosis and upper pole hollowness. The addition of AFG to the modified LIFT technique can be considered a step forward in achieving autoaugmentation and autologous mastopexy without using implants.

Background: Achieving an aesthetic balance and natural appearance when modifying soft tissues of the nasal tip, alae, and nostrils is fundamental to the success of rhinoplasty surgery. The present study aimed to investigate the ability of a simple “sandwich” technique combined with external alar base reduction to preserve the alar flare and achieve a natural and appealing alar contour. Methods: The study included 40 patients who reported dissatisfaction due to excessive nasal flaring. Cartilaginous grafts were harvested from the septum in cases of primary rhinoplasty. Grafts were harvested from the conchal cartilage in cases of secondary rhinoplasty to ensure adequacy of the grafts. The grafts were inserted from the alar wedge excision point along the created pocket to be “sandwiched” in the soft tissue of the alar rim. Results: The average preoperative alar flare was 35.2 mm (SD ±1.9 mm), with an average postoperative reduction of 3 mm. Difference between intercanthal distance and postoperative alar flare distance showed a mean of (−0.4 mm) (SD ±1.2 mm) and was highly significant with P < 0.05. A comparison between nasal base width and alar flare measurements was done. Difference between nasal base width and preoperative alar flare distance was (−9.2 mm) (SD ±2.6), and between nasal base width and postoperative alar flare was (−6.3 mm) (SD ±2.1). Postoperatively, overall patient satisfaction was scored 4.1 of 5. Conclusion: The use of a trapezoidal graft, in combination with external alar base reduction, markedly improves the basal view while maintaining the natural alar flare and curvature.

Background: In the years after unilateral breast reconstruction, the reconstructed breast resists ptosis more than natural breast tissue in the native contralateral breast. As acellular dermal matrix (ADM) becomes fully incorporated into the recipient’s anatomy, thus reinforcing the inferior pole of the uplifted breast, we combined our mastopexy cases with ADM in an attempt to reduce the rate of recurrent ptosis. Method: This was a prospective randomized analysis of a cohort of 24 patients, divided into two groups (A and B); all underwent primary unilateral mastopexy to correct grade III breast ptosis. Our patients had previously undergone contralateral skin sparing mastectomy with immediate breast reconstruction, for invasive breast cancer or ductal carcinoma in situ that originally was symmetrical to their native breast. The symmetrization mastopexy in half of our patients was carried out with the addition of an ADM sling to the inferior pole of the breast, to act as an internal, subcutaneous supportive “bra” (A). The other half of patients received a standard symmetrization mastopexy, without the addition of an ADM support (B). Patients were followed up for 36 months. Results: The difference between control arm and study groups revealed a statistical difference (P < 0.05), when comparing the follow-up period. From the sixth postoperative month onward, the measurements for group A revealed a statistically significant difference (P < 0.05) when compared with group B. Conclusion: The additional ADM sling acts as an added layer of support, thus delaying reoccurrence of ptosis following mastopexy.