Septum-Based Augmentation Mastopexy for Moderate to Severe Ptosis in Medium to Large Breasts: A Retrospective Cohort...

Augmentation mastopexy is complex due to the biomechanical conflict between lifting ptotic tissue and introducing volume with implants. In medium-sized to large breasts or in patients with poor tissue quality, the imbalance between native parenchyma and implant weight may lead to recurrent ptosis, bottoming out, and aesthetic dissatisfaction. Clinical outcomes and patient satisfaction after a septum-based parenchymal reduction technique combined with dual-plane augmentation were investigated.

The authors conducted a retrospective review of a multicenter database including 238 patients who underwent bilateral septum-based augmentation mastopexy from January of 2018 through May of 2023. Inclusion criteria were age 18 years or older, Regnault grade 2 or 3 ptosis, and follow-up of at least 12 months. The technique involved wide parenchymal resection on a vascularized medial pedicle including the internal septum, followed by dual-plane implant placement. Patient-reported outcomes were assessed using BREAST-Q Augmentation and Reduction/Mastopexy modules preoperatively and at 30 days and 6 and 12 months after surgery. Rasch-transformed scores were analyzed using Wilcoxon signed rank tests ( P < 0.05).

The mean patient age was 35.2 years and the mean body mass index was 23.6 kg/m 2 . The average implant volume was 345.1 cc. Statistically significant improvements ( P < 0.05) were observed in all BREAST-Q domains. The overall complication rate was 11.3% (reoperation rate, 5.9%). Recurrent ptosis occurred in 1.3%. No cases of breast implant-associated anaplastic large cell lymphoma were reported.

Septum-based augmentation mastopexy appears safe and reliable in moderate to severe ptosis, especially in medium-sized to large breasts. The technique allows controlled tissue reduction, maintains vascularity, and improves implant integration. Patient satisfaction and complication rates are favorable compared with the literature. However, further prospective studies are needed to confirm long-term stability and refine patient selection criteria.