Dermal Triangular Flaps to Prevent Pseudoptosis in Mastopexy Surgery: The Hammock Technique

Abstract

Background: Mastopexy is one of the most performed cosmetic surgery procedures in the United States. Despite the numerous mastopexy techniques that were published in the past decades, preventing pseudoptosis to ensure longer lasting results remains the principal challenge. Objectives: This paper describes a new mastopexy technique developed for moderate to severe ptosis/pseudoptosis associated with upper pole deflation. Considering some of the commonest risk factors generally considered predictive of worse outcomes (massive weight loss, multiple pregnancies, skin quality, smoking, age), we aimed to assess whether this technique could be beneficial in the support of the desired breast shape over time. Methods: Twelve patients, all featuring 1 or more of the abovementioned preoperative risk factors, were operated on by the same senior surgeon with the hammock mastopexy technique using dermal flaps as a support for the glandular reshaping (6 bilateral mastopexies and 6 unilateral mastopexies for contralateral symmetrization after breast reconstruction). Patients’ characteristics, such as smoking, weight loss, or multiparity with consequent inelastic skin, age, and lengthy nipple–areola complex lift, were considered as independent risk factors for ptosis recurrence and bottoming out. Patients were divided into 3 subgroups according to the number of their risk factors. Aesthetic results were assessed at 12 months postoperatively. Changes in postoperative were assessed for each patient by breast measurements and a superposition of the standardized breast photographs. Long-term outcomes were compared with a control group of 6 patients who benefited from mastopexy without “hammock technique.” Results: Satisfactory maintenance of shape and stable nipple–areola complex position was seen at 12 months regardless of the number of risk factors. However, a statistically significant difference was found in lower pole lengthening between patients with more than 3 risk factors compared to other groups. Aesthetic measurement results were consistent between the patient and surgeon reporting a satisfying cosmetic result, regardless of the number of risk factors. In the control group, we found a significant increase in breast lower pole measurements at 12 months when compared with the hammock group. Conclusions: This mastopexy technique improves projection and reinforces the lower pole support with lateral and medial dermal flaps. The technique is safe and reliable and provides easily reproducible results for patients with risk factors for postoperative pseudoptosis.

Longevity of ptosis correction in mastopexy and reduction mammaplasty: A systematic review of techniques

“…These include pillar sutures, permanent and absorbable meshes, lipofilling, dermal or dermoglandular slings, autoaugmentation flaps, and muscular slings. 2 , 3 , 4 , 6 , 9 , 11 , 15 , 16 , 17 , 18 , 20 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 The meshes used were variable and permanent or partially absorbable meshes generally had better outcomes compared to fully absorbable meshes. Hamdi et al.…”

“…These flaps are inferiorly based and secured to the pectoralis muscle or chest wall to provide added support to the breast parenchyma. 4 , 26 , 29 Watfa et al. compared six patients undergoing standard wise pattern superior pedicle mastopexy to 12 patients undergoing the same procedure with the addition of a dermal suspensory hammock flap and found a significant increase in lower pole arc length in the standard mastopexy group but no change in SN-N distance.…”

“…compared six patients undergoing standard wise pattern superior pedicle mastopexy to 12 patients undergoing the same procedure with the addition of a dermal suspensory hammock flap and found a significant increase in lower pole arc length in the standard mastopexy group but no change in SN-N distance. 4 Another autologous option requiring more extensive dissection is the pectoralis major muscle sling or the pectoralis facia suspension. 2 , 33 , 34 , 35 In the only randomized controlled study included in this review, Graf et al.…”

“…Some studies comment on this phenomenon; however, no studies stratified outcomes based on post-operative weight loss or gain. 4 , 7 , 31 , 36 Mastopexy and breast reduction procedures should be performed when patients reach a stable weight, and patients should be counseled pre-operatively that significant changes in weight can affect the longevity of results. If additional weight loss is planned, then the procedure should be delayed when possible.…”

“…The breast mound is positioned above the IMF on the chest wall, and there is adequate upper pole fullness. 4 , 5 …”