Balancing the Breast: Transsternal Cable Grafts as a Libra in Mastopexy for Long Term Symmetry and Projection

Recurrent ptosis, loss of upper pole fullness, and postoperative asymmetry remain persistent challenges in mastopexy surgery. Most conventional techniques primarily rely on a vertical support vector, which may be insufficient to resist long-term gravitational descent and asymmetric settling. To address these limitations, we describe a modified mastopexy technique using transsternal dermal cable grafts to provide additional horizontal vector support and improve breast stability. The technique was performed in 75 women undergoing inverted-T scar central mound mastopexy. Transsternal dermal grafts were designed as a dual-vector suspension system connecting the medial breast pillars across the presternal region, reinforcing medial fullness, projection, and symmetric breast positioning. The grafts function as an internal balancing mechanism, analogous to a libra, while preserving breast mobility and contour. Clinical follow-up demonstrated stable breast shape, improved upper pole fullness, enhanced projection, and satisfactory symmetry over time. Minor wound-healing problems and hypertrophic scarring occurred in a limited number of patients, whereas nipple-areola sensation was preserved in all patients. This technique introduces a structurally reinforced dual-vector mastopexy concept that combines vertical reshaping with horizontal stabilization. Transsternal cable grafts may help reduce recurrent ptosis and asymmetric breast settling while improving long-term breast contour and projection.