Dual-pedicle dermoparenchymal mastopexy

Mastopexy for treatment of breast ptosis, with or without augmentation or reduction, is often followed by recurrent ptosis. A new mastopexy technique is described which appears to offer long-term correction. After conservative resection of excess skin, the breast parenchyma is elevated from the chest wall, and redundant caudal deepithelialized breast tissue is divided into two equal (or unequal) superiorly based pedicles. These are criss-crossed (as in folding of arms), overlapped, and secured to the pectoral fascia in a position cephalad to the nipple-areolar complex. This technique, dual-pedicle dermoparenchymal mastopexy (DPM), forms a cone of the breast tissue and provides a "cradle" of support. It permits insertion of a prosthesis if needed. Based, in part, on concepts of traditional and more recently described pedicled breast reductions, it enjoys the advantage of preserving skin attachment to underlying unresected breast parenchyma. In addition, it repositions ptotically displaced breast parenchyma into a cephalad position and fixes it (the "pexy") to the chest wall. A 10-year experience is presented with representative cases to illustrate the basic mastopexy and its use with augmentation or reduction.