Autologous augmentation-mastopexy after bariatric surgery: waste not want not!

The escalating trend in obesity is having major impact on health and the economy. As a result of NHS policies to reduce obesity, the number of patients losing weight following bariatric surgery is increasing rapidly. In addition to the systemic benefits to their general health, dramatic weight loss leads to marked changes in body habitus, with many patients seeking further "aesthetic" surgery to improve their appearance. We present our technique of autologous augmentation-mastopexy to address the problems of both skin excess and insufficient breast volume.

Our chosen method for mastopexy uses the Wise-pattern skin excision. Augmentation of the breast deficient in volume is provided by a pedicled subcutaneous lateral thoracic perforator-based flap raised via a vertical continuation of the lateral mastopexy incision superiorly, often in continuity with a simultaneous brachioplasty incision.

Thus far, six patients have undergone autologous augmentation mastopexy following massive weight loss (range = 36-79 kg, mean = 61 kg). Follow-up of these patients ranged from 1 to 18 months (mean = 12.5 months). Postoperative complications included a donor site seroma, haematoma, and scar contracture. All patients tolerated the procedure well and they felt that the improvement in breast and chest wall contour more than compensated for the donor site scar on the lateral chest wall.

Autologous augmentation-mastopexy provides a robust augmentation, giving more natural ptotic breasts while avoiding the cost and potential complications of implant augmentation. The increased lateral flank scarring is well tolerated by these patients, with the additional benefit of reducing flank fullness.