PRISMA (Pectoralis-Rib Implant Support and Muscle Adjustment): An Innovative Technique for Secondary Mastopexy

Secondary mastopexy following breast augmentation is technically challenging due to altered anatomy, compromised soft tissues, and increased complication risk. This study aims to describe a novel technique (PRISMA [pectoralis-rib implant support and muscle adjustment]) incorporating dual-plane implant placement with muscular support and to evaluate its safety and aesthetic outcomes in revisionary cases.

A prospective observational cohort study was conducted on 74 female patients undergoing secondary mastopexy between January 2023 and January 2026. All patients had prior breast augmentation and underwent surgery using a modified dual-plane technique with muscular fixation. Standardized anthropometric breast measurements were obtained preoperatively, immediately postoperatively, and at 12 months. Descriptive statistics and paired t tests were used for analysis.

Mean age was 44 years, and all patients underwent dual-plane implant placement. Correction of ptosis was achieved in all cases. Improvements were observed in anthropometric parameters, including clavicle-to-nipple distance (mean reduction of ~ 5.3 cm bilaterally; P < 0.001) and clavicle-to-upper implant border distance (P < 0.001), indicating improved nipple position and upper pole fullness. Inferior pole measurements demonstrated controlled expansion without bottoming out. Outcomes remained stable at 12 months. The overall complication rate was 6.76%, with no cases of infection, hematoma, or total nipple-areola complex necrosis.

The PRISMA technique demonstrated effective and durable correction of ptosis with stable anatomical repositioning and low complication rates. Objective anthropometric analysis supports its reproducibility and structural reliability in secondary mastopexy. Despite limitations, this approach represents a safe and effective option for complex revision breast surgery.