[Classification and operative tactic in the treatment of the small ptotic breast (author's transl)]

The deceiving results obtained by the single implantation of mammary prostheses in the treatment of the small ptotic breasts are the consequence of faulty judgment and lack of recognition of the various anatomical elements involved in the deformity and which bear an incidence on the operative technique and the final esthetic result. By studying the three inseparable elements -ptosis, skin and hypoplasia -a classification into three types of small ptotic breasts is proposed, based mainly on the origin of the ptosis and the hypoplasia and on the static qualities of suspension and coverage of the skin : Type I : primary small ptotic breast. Type II : secondary small ptotic breast with normal skin. Type III : secondary small ptotic breast with skin of bad quality. The respective indications and prognosis of the classical methods of treatment are reviewed according to this classification. The single implantation of mammary prostheses has only restricted indications : when the ptosis of the nipple and/or the lower pole of the breast does not exceed 1 tot 1,5 cm. In all the cases where the ptosis is more pronounced, the single implantation is contraindicated and a reshaping operation will be performed. In cases where the reshaping operation does not give enough volume to the breast, a two-stage procedure is strongly recommended by the author : a reshaping operation, followed in a second stage by the implantation of the adequate prosthesis as soon as the local conditions are favorable.