The Octopus Mastopexy: A True "Implant-First" and On-Demand Approach Based on Parenchymal Reduction

Simultaneous augmentation mastopexy represents one of the most demanding procedures in aesthetic breast surgery, due to the need to balance volume enhancement with tissue tightening. Traditional techniques often struggle to maintain long-term stability, frequently resulting in recurrent ptosis, increased tension on the wound closure, and higher complication and revision rates. The Octopus Mastopexy was developed as a standardized refinement of the inverted-T approach, aiming to provide a reproducible, tension-free result while ensuring reliable nipple-areolar complex vascularization. A retrospective review was conducted of patients who underwent primary or secondary augmentation mastopexy using the Octopus technique between January 2019 and January 2024, all performed by the senior author. The technique is characterized by an implant-first sequence, selective and on-demand parenchymal reduction, and multivector pillar mobilization to evenly redistribute tension across the breast mound. Patient-reported satisfaction and quality-of-life outcomes were assessed using the BREAST-Q questionnaire, administered preoperatively and again at least 12 months postoperatively. Ninety-five patients were included, with a mean age of 39.2 years and a mean implant volume of 300 cc. No major complications occurred. Minor wound dehiscence was observed in two patients and managed conservatively, while six patients required revision for recurrent glandular laxity or weight change. BREAST-Q scores improved significantly across all measured domains, including satisfaction with breasts, physical well-being, and psychosocial well-being. These findings suggest that the Octopus Mastopexy provides a safe, stable, and reproducible solution for simultaneous breast augmentation and mastopexy, improving aesthetic outcomes while reducing tension-related complications and revision rates.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .