Augmentation, Mastopexy, and Augmentation-Mastopexy: Navigating Surgical Decision-Making and Optimizing Outcomes

Breast augmentation, mastopexy, and combined augmentation-mastopexy are among the most commonly performed esthetic breast procedures; however, achieving optimal outcomes remains difficult due to the complex interplay between patient anatomy, surgical technique, and competing procedural goals. This review provides a comprehensive, up-to-date synthesis of current approaches to preoperative planning, operative decision-making, and complication management across these procedures. Successful outcomes begin with a thorough patient assessment, including evaluation of breast dimensions, tissue characteristics, degree of ptosis, and patient-specific aesthetic goals. In augmentation, key considerations include incision selection, implant characteristics, and pocket plane placement, all of which directly influence complication profiles and aesthetic outcomes. Mastopexy focuses on reshaping the breast and repositioning the nipple-areola complex, with technique selection guided primarily by ptosis severity and tissue quality. Simultaneous augmentation-mastopexy presents unique challenges due to the opposing forces of volume expansion and skin envelope reduction, contributing to higher rates of wound healing complications, recurrent ptosis, and revision surgery. Careful patient selection, tissue-based planning principles, and techniques emphasizing implant stability are critical to optimizing outcomes in combined procedures. Common complications across procedures include infection, capsular contracture, implant malposition, wound healing issues, and aesthetic deformities, each requiring tailored management strategies. Special considerations, including massive weight loss patients and gender-affirming surgery, further underscore the need for individualized surgical planning. Ultimately, optimizing outcomes in aesthetic breast surgery relies on a comprehensive, patient-centered approach that integrates anatomic assessment, evidence-based technique selection, and meticulous surgical execution.