1. One-Stage Mastopexy with Breast Augmentation: A Review of 321 Patients W. Grant Stevens, M.D. Mark E. Freeman, M.D. David A. Stoker, M.D. Suzanne M. Quardt, M.D. Robert Cohen, M.D. Elliot M. Hirsch, M.D. Marina del Rey and Los Angeles, Calif. PRSJ NOVEMBER 2007

2. Background:
Although some recommended a staged mastopexy and breast augmentation there are currently no large studies evaluating the safety and efficacy of a one-stage procedure.

3. Methods:
A retrospective chart review was conducted of 321 consecutive patients who underwent one stage mastopexy and breast augmentation over 14 years period ( ).
Average follow up was 40 months.

4. All patients had preoperative and postoperative photographs, general anesthesia, lower extremity sequential compression devices, perioperative antibiotics, extensive undermininig of mastopexy flaps was avoided, no drains were used and the patients ambulated the day of the sugery.

5. Each patient age, smoking status, type of mastopexy (inverted T, vertical, circumareolar, or crescent), implant related data and pocket position (subglandular versus submuscular).

6. Complications were divided into two categories: implant related (deflation, capsular contracture, malposition and palpability) and tissue related (asymmetry, poor scaring, ptosis, lost of nipple sentation, infection, hematoma, depigmantation).

7. Results:
There were 25 unilateral and 296 bilateral cases, leading to 617 individual breast procedures. 118 patients had undergone some form of previous breast surgery and 203 were primary cases.

9. 1-An incision is made along circle A from the 1 o´clock position to 11 o´clock , creating a neonipple of 5 to 10mm in greatest diameter .
2- A second incision is made along circle B from the o´clock position to 11 o´clock, preserving 5 to 7 mm of height.

10. 3-The base of the lateral wing flap is incised along circle C.
4-A longitudinal incision from circle A to circle C at the 6 o´clock position is made

11. 5-Two lateral wing flaps, 1 to 1.5 mm thick, are elevated laterally.
6-The crescent between A and B is deepithelialized, and the stromal tissue containing the lactiferous ducts is conservatively trimmed to reduce nipple diameter and height, attention is paid to preserve the central core containing the neurovascular bundle and lactiferous ducts.

12. The most common previous procedure was breast augmentation (79 patients). Average age was 39 years. 28 patients (8.7%) smoked cigarettes before surgery but agree to stop smoking at least 2 weeks before the surgery.

13. Saline implants were used in 191 breasts (31%) and silicone implants were used in 426 (69%). Average volume of implant was 317cc. 280 patients (87%) had the implant placed in a submuscular pocket and 41 patients (13%) had a subglandular pocket.
Distribution of techniques were inverted T 60%, circumareolar 21%, vertical 15%, crescent 4%.