Double Dermoglandular Reposition Mastopexy in Severely Ptotic and Flat Breasts

Severely ptotic and flat breasts pose significant reconstructive and aesthetic challenges due to poor skin elasticity and attenuated support structures, which limit the stability of upper pole projection. Augmentation mastopexy using implants may increase the risk of nipple-areola complex vascular compromise, and many patients prefer to maintain or reduce breast volume. Between 2022 and 2024, we performed vertical mastopexy with a double dermoglandular reposition technique in 31 patients (mean age, 38 years) to address severe ptosis without implants. The approach combines an inferior pedicled dermoglandular flap, folded and anchored to the pectoralis fascia to restore central projection, with a superior pedicled dermoglandular flap, rotated into an upper pole pocket to recreate convexity. Each flap maintains an independent vascular pedicle, allowing simultaneous restoration of projection and upper pole fullness with minimal risk of ischemia. Average operative time was 175 minutes, and only minor complications were observed; no flap necrosis occurred. At 12 months, the upper pole contour and projection appeared qualitatively stable. In this single-surgeon series, early outcomes suggest that this implant-free technique may offer a short-term, safe option for challenging ptosis cases with adequate residual tissue, while avoiding prosthetic-related complications. Larger prospective studies with long-term follow-up and objective volumetric assessment will be necessary to confirm durability.Clinical Question/Level of Evidence: Therapeutic, IV.