Evaluation of Inferior Pedicle Therapeutic Mammoplasty as a Primary Procedure for Upper Quadrants Early Breast Cancer

Background: The treatment of breast cancer in large breast patients represents a great challenge to both surgical oncologist and radiation oncologist. The aim of this study is to evaluate the outcome of inferior pedicle therapeutic mammoplasty in large-breasted patients with upper quadrants early breast cancer. Methods: Thirty five large-breasted patients with early breast cancer were included in this study. Simultaneous bilateral inferior pedicle therapeutic mammoplasty was performed. Results: The age of the patients is ranged from 36 to 61 (median 46) years and tumour size is ranged from one to three and half cm. The weight of tissue removed is ranged from 350 gm to 780 gm and the tumour safety margins are ranged from three to eight cm. Wound dehiscence was the commonest post operative complications and six patients were affected (17.6%). The cosmetic outcome was excellent in 22 patients (64.5%), nine patients (26.5%) showed good results, two patients (6%) were satisfactory and one patient (3%) showed poor result. The follow up period is ranged from 6 to 42 months with one case (3%) of systemic metastasis. Conclusion: Inferior pedicle therapeutic reduction mammoplasty for upper quadrants early breast cancer in large breasted women is a surgically and oncologically safe procedure, and it carries a satisfactory aesthetic outcome.

Therapeutic Mammoplasty in Management of Breast Cancer: A Prospective Clinical Study

Background: The introduction of oncoplasticbreast surgery, with a concomitant contralateral symmetrization procedure, allows the surgical oncologist the freedom to perform wider excisions, with more favorable cosmetic outcomes. Objective: To assess the feasibility of bilateral breast reduction for the management of breast cancer, and to determine the most suitable surgical technique of therapeutic mammoplasty for each patient. And to evaluate the cosmetic outcome during the postoperative period. Methods: This study was from June 2014 until June 2016, and included 86 female patients with breast cancer;divided in 3 groups;group A;had bilateral superior pedicle reduction mammoplasty, group B;had bilateral inferior pedicle reduction mammoplasty, group C;had bilateral batwing mastopexy. 1 month postoperative, patients were asked to answer a 5-scale questionnaire evaluating their own cosmetic outcome. Criteria they were asked to evaluate were: symmetry, shape and volume, projection, correction of ptosis, visibility of the scars and overall satisfaction. A similar questionnaire was answered by a panel made up of a surgeon and breast-care nurse after seeing the pre- and post-operative photos of the patients in question. Results: Group A had a mean tumor size of 2.7 ± 0.69 cm, least resected margins 1.2 - 4.3 cm, Group B had a mean tumor size of 3.2 ± 1.19 cm, least resected margins 0.7 - 3.8 cm, Group C had a mean tumor size of 3.4 ± 1.12 cm, least resected margins 1.7 - 5.2 cm. Cosmetic results fared high above average. Group C fared better in overall satisfaction but Group B fared better in ptosis correction, projection and symmetry. The panel answers showed difference regarding shape and volume;the only two criteria to be almost of the same result among the three groups. Conclusion: Bilateral TM has some advantages when compared to standard conventional BCS techniques without having any unfavorable effects on surgical margin confidence, local recurrence, and survival rates. So, it is a valuable addition to consider the use of such surgical techniques whenever indicated in the surgical management of patients with breast cancer. Batwing mastopexy showed superiority in operating time, hospital stay and overall satisfaction of patients, surgeons and nurses.

Retrospective: Mammoplasty with Prosthesis after Video-Assisted Bariatric Surgery with Transverse Bipediculated Flap

Objective: To assess the rate of mammary prosthesis extrusion after mammoplasty with prosthesis implantation, to verify the resulting shape and the degree of patient satisfaction after the use of a transverse bipediculated flap with lateral irrigations. Methods: 30 patients with a weight loss of 50 kg on average after video-assisted bariatric surgery, with ptosis and excessive volumes, who underwent mammoplasty with prosthesis placement with volumes ranging from 190 to 260 cc, using a transverse flap with the aim of anchoring the silicone prosthesis. Results: In the patients’ evaluation, the few postoperative complaints did not amount to complications. Pains were minimal and the discomfort with the prosthesis was acceptable. Conclusion: the transverse flap, in addition to acting as the best anchor among the existing flaps for implanted prostheses, provided a youthful, natural, anatomical, aesthetic and longer lasting appearance for the breasts.

Versatility of therapeutic reduction mammoplasty in oncoplastic breast conserving surgery

Oncoplastic breast conserving surgery is the gold standard approach for the surgical treatment of early breast cancer. There is a well defined technique named "therapeutic mammoplasty" which is characterized for using a reduction mammaplasty technique to treat breast cancer conservatively. In our current practice, "therapeutic mammoplasty" or therapeutic reduction mammaplasty is our favorite oncoplastic breast conserving approach which it used in almost half of our patients. This technique is very versatile allows us the resection of tumors located in all breast quadrants of patients with moderate-to large-sized breasts. We describe a series of 57 patients who were treated using a therapeutic reduction mammaplasty. All surgical procedures were carried out by one comprehensive breast surgeon who planned and designed the surgery performing both oncologic and reconstructive procedures. Surgical margins were insufficient in eight patients(14%). Nine patients(15.8%) had a complication in early postoperative period and in one of them adjuvant radiotherapy was delayed four months due to a wound dehiscence. The rate of synchronous contralateral symmetrization was 31.6%. Our conclusion is that reduction mammaplasty is a useful and safe skill to treat breast cancer conservatively playing a very important role therefore it must be situated in the priority of learning objectives.

Augmentation mammoplasty with autologous fat grafting

Considering the issues that can accompany prosthetic breast implants,augmentation mammoplasty(AM)with autologous fat grafting(AFG)has attracted growing interest globally,especially in the last two decades,as breast implant-associated anaplastic large cell lymphoma has been increasing in incidence over time.Here,we review the detailed processes of AFG to the breast and the pertinent complications associated with this procedure.This study aims to elucidate the critical points and technique improvements in AM with AFG in recent years,as well as discuss how to decrease complications related to this procedure.Attention was focused on the specific AFG steps,clinical outcomes,and complications to highlight the advantages and disadvantages of the available protocols.

Upper Footprint Dependent Nipple Position to Avoid High-Riding Nipple after Reduction Mammoplasty

Introduction: High-riding nipple following reduction mammoplasty is a challenging problem for the plastic surgeons. To avoid such problem, many methods have been described for marking the correct nipple position but still controversial. We aimed in this study to present our experience in preventing excessive nipple elevation after reduction mammoplasty by using the upper footprint to set the new nipple position. Material and Methods: From March 2019 to March 2022, 25 female patients at a mean age of 38.3 years were included in this prospective study. They underwent reduction mammoplasty with inverted T scar and a combination of inferior pedicle and Würinger’s septum techniques. Resection weights, pre- and postoperative anthropometric measures were recorded. All patients were photographed at the follow-up visits and evaluated for complications if any, the nipple-areola complex (NAC) sensation, and subjective patient satisfaction using “The Breast Evaluation Questionnaire”. Results: The mean preoperative midclavicular point to nipple distance was 37.40 and 37.18 cm for the right and left breasts, respectively. The mean resection weight was 1270 and 1242 g from the right and left sides, respectively. None of our patients experienced NAC necrosis, while 2 breasts had minor wound dehiscence treated conservatively. After a mean follow-up period of 12 months, the NAC descended by an average of 1.40 cm, the distance from the IMF to nipple had an average increase of 2.24 cm, and all of patients were satisfied with the esthetic outcomes and convinced with their breast shape. Conclusion: The upper footprint dependent nipple position seems to have a real role in preventing high-riding nipple after breast reduction in hypertrophic and gigantomastic breasts. Moreover, it can be applied easily and allow for more satisfying outcomes than other methods for setting the new nipple position.

Augmentation mastopexy and augmentation mammoplasty:an analysis of 1,406 consecutive cases

Aim:Simultaneous augmentation mastopexy is a challenging operation for esthetic plastic surgeons.Complication and revision rates following augmentation mammoplasty or mastopexy are less commonly seen when these two procedures are performed separately.However,when the two procedures are combined,the complication rate is reported exponentially higher when compared with its individual component carried out separately.The current retrospective chart review is a comparative analysis of the two procedures performed by a single surgeon.Methods:Retrospective data were collected using patient’s charts.All patients who had augmentation mammoplasty(Group A)or simultaneous augmentation with mastopexy(Group B)in muscle splitting biplane using round cohesive gel textured silicone implants by a single surgeon were included.Results:A total of 1,406 patients had consecutive augmentation mammoplasty or simultaneous augmentation mastopexy.Augmentation mammoplasty(Group A)included 1,298 and simultaneous augmentation with mastopexy(Group B)had 108 patients,respectively.The mean age of the patients in Group A and B was 29.6 years and 32.2 years,respectively(P=0.006).The mean size of the implants in Group A and B was 340 mL and 308 mL(P=0.001),respectively.Wound infection in Group A and B was seen in 0.6%and 3.7%,respectively.Wound breakdown was seen in 1.1%in Group A as compared to 6.5%in Group B(P=0.001).Revision surgeries were performed in 1.4%and 11.1%of Group A and B,respectively(P=0.001).Conclusion:There was a statistically and clinically significant higher rate of complications and revision rate noted in simultaneous augmentation with mastopexy(Group B)as compared to augmentation mammoplasty alone(Group A).However,the rise in complications rate is sum of the complications of the two individual components performed and not exponential.

One-stage mastopexy and augmentation mammoplasty in layers: outcome analysis of first 50 consecutive cases

Aim: The single-stage procedure is a challenging procedure for Plastic Surgeons. The single-stage layered mastopexy with augmentation is a new technique that is aiming to add safety, preserving breast function and to restore normal parameters of breast. Methods: A retrospective chart review of 50 consecutive cases of layered mastopexy with augmentation mammoplasties was performed. All patients had their implants placed in muscle splitting pocket. Incisions for mastopexy were selected on the basis of nipple areolar complex to inframammary crease. Mastopexy is performed using a medially based pedicle, leaving a sufficient tissue covering the implant. Patients were divided into three groups. Group 'A' who had periareolar mastopexy, Group 'B' had vertical scar mastopexy and Group 'C' patients had mastopexy with Wise pattern markings. Results: Group A comprised 11 patients. The mean age was 28.82± 7.01 years, mean preoperative and postoperative nipple areolar complex (NAC) to IMC measurement was recorded in 10 patients with the mean of 7.15± 1.98 cm and 8.35± 1.18 cm respectively. Mean size of the implant used was 379.55± 77.18 cm3. Group B comprised 29 patients. Mean age was 35.17± 12.37 years and the mean preoperative and postoperative NAC to IMC crease was 8.53± 1.48 cm and 9.72± 1.51 cm respectively. The mean implant size used was 289.48± 109 cm3. Group C had 10 patients. Mean age was 39.60± 12.15 years and the mean preoperative and postoperative NAC to IMC crease of 10.11± 1.24 cm and 8.75± 0.98 cm respectively. The mean implant size used was 287.00± 55.08 cm3. Conclusion: The procedure allows better arterial supply, wider area for venous and lymphatic drainage, better sensory innervation to NAC and maximises lactation potential of the breast.

A mammometric comparison of modified Robertson versus Wise pattern inferior pedicle reduction mammoplasty

Aim:The advent of 3D photoimaging and mammometrics has allowed for quantitative,volumetric breast analyses.This study uses 3D photoimaging and mammometrics to compare the postoperative morphometric outcomes of the modified Robertson technique to the more traditional Wise pattern inferior pedicle technique.Methods:Inferior pedicle reduction mammoplasty was performed using either a Wise pattern or modified Robertson skin incision.3D photography and analysis were done at 1-3 months and 6-12 months postoperatively.Results:There were 14 breasts in the modified Robertson group(ROB)and 24 breasts in the Wise pattern group(WISE).There were no significant differences in demographic data or amount of tissue resected.At 6-12 months,the modified Robertson cohort demonstrated increased superior pole fullness(62.9%ROB vs.58.3%WISE,P=0.05).The Wise cohort,however,maintained greater maximum breast projection(5.52 cm ROB vs.6.54 cm WISE,P=0.01)and increased medial pole fullness(29.6%ROB vs.46.9%WISE,P<0.01).There was no difference in tissue shifting from the superior pole to the inferior pole over time(+3.36 superior pole%ROB vs.+1.42 superior pole%WISE,P=0.28).Areola surface area increased equally in both cohorts(+3.08 cm2 ROB vs.+2.59 cm2 WISE,P=0.77);however,the final size of the areola was greater in the modified Robertson cohort(26.9 cm2 ROB vs.21.6 cm2 WISE,P<0.01).Conclusion:Using 3D mammometrics,we found increased superior pole fullness in the modified Robertson group while the Wise pattern group demonstrated greater medial pole fullness and maximum breast projection.

Use of the multiplane internal mastopexy for ptosis correction revision-augmentation mammoplasty

Aim:Augmentation mammoplasty is a commonly performed procedure with a high satisfaction rate.Multiplane pocket was described for simultaneous internal mastopexy and augmentation using inframammary crease incision for selected primary and secondary mammoplasties.The use of the technique is presented with a larger experience for correction of ptosis in a patient presenting for revision surgery following subglandular augmentation mammoplasty.Methods:A retrospectively collected data were analyzed using the Excel Spread Sheet.A total of 25 patients had multiplane augmentation with the internal mastopexy following augmentation mammoplasty in subglandular pocket.Data of 25 patients who had their revision surgery in multiplane were analyzed.Results:The group included 25 patients with a mean age of 36.6 years(range:25-54 years)with mean implant duration of 6.4 years(range:1.5-13 years).Twenty-three of the patients were nonsmokers,1 smoker and 1 patient’s smoking status was not mentioned.Eighteen patients presented with grade I capsular contracture,3 patients with grade II contracture and 4 patients had a combination of grade I and II capsular contracture.Pseudoptosis was present in 6,class B ptosis in 6,A/B ptosis in 3,water-down deformity in 5 and rippling in 5 patients.Average preoperative size of implant used initially was 334.4 mL(range:250-340 mL)and the mean implant size selected for revision surgery was 416 mL(range:260-525 mL).Mean follow-up time was 18 months(range:6-48 months).Of 25 patients,21 had a bilateral procedure whereas the technique was used unilaterally in 4 patients for the correction of asymmetry.All patients had a single dose of intravenous antibiotics and followed by an oral course for 5 days,there was no infection noted in the series.In the current series,no patient required revision surgery following the multiplane internal mastopexy.Conclusion:Multiplane internal mastopexy can be useful in selected cases of revisionary augmentation mammoplasty.

The Effects of Moufarrege Total Posterior Pedicle Reduction Mammaplasty on Breast Cancer Incidence

Introduction: The Moufarrege total posterior pedicle breast reduction involves complete denudation of the breast offering free access to all breast quadrants. This allows a total resection of the upper outer quadrant which is most implicated in breast cancer. The objective was to assess the postoperative incidence of breast cancer in the cohort of women who underwent the Moufarrege technique. Methods: Retrospective chart review was performed for patients operated on between 1981 and 1997, and a written questionnaire was sent to all patients in 2008. Patients were asked about the date of their last mammogram and any diagnosis of breast cancer. Expected numbers of cancers were calculated from rates in the general population. Age standardization at the time of surgery was done and the incidence of breast cancer was calculated in relation to age at time of surgery and age at last follow-up. Results were presented as standardized incidence ratios (SIR) with their corresponding 95% confidence interval (CI). Results: We included 924 patients. The response rate was 60.38% (n = 558). Mean patient age at the time of the surgery was 32.8 years (14 to 82). Mean resection weight was 620 grs per breast (250 - 1600). Breast cancer was significantly reduced by nearly 64 percent in patients who responded to our questionnaire and were aged 35 years or more at the time of surgery ([SIR] = 0.36;95 % [CI] 0.09 - 0.93). No difference in breast cancer incidence was observed in patients aged less than 25 years at the time of the surgery. Conclusion: The Moufarrege Total Posterior Pedicle breast reduction is a reliable and safe procedure that may offer a superior breast cancer risk reduction based on the results of our retrospective chart review and patient questionnaire.

Oncoplastic Breast Surgery Using Spindle Shaped-Partial Mastectomy for Early Breast Cancer in the Upper Quadrant Area

Background: Oncoplastic surgery is becoming more common, however, only several reports have been published in Japan. We report the results of simple oncoplastic surgery for Japanese patients with early breast cancer in the upper quadrant area. Methods: In seven patients with a past history of breast-feeding and ptotic breasts, we performed oncoplastic surgery involving partial mastectomy and the resection of excess skin and parenchymal tissue. Results: None of the patients received a contralateral operation to produce symmetrical breasts. The width of the resected excess skin tissue ranged from 20 to 50 mm, with the mean width being 30 mm, and its length ranged from 50 to 90, with the mean length being 77 mm. The width of the resected gland tissue ranged from 40 to 65 mm, with the mean width being 53 mm, and its length ranged from 70 to 100 mm, with the mean length being 97 mm. The cosmetic results were excellent. Conclusions: Oncoplastic surgery using spindle shaped-resection was successfully performed in patients with upper quadrant lesions, and the cosmetic results were excellent.

Applying the Passot technique in the surgical treatment of severe gynecomastia:A case report and literature review

Gynecomastia is emerging as a major cosmetic and physiological concern among adolescents, especially in relation to obesity, acute weight loss following surgery, and other endocrine illnesses. Surgical treatment involves liposuction(mechanical, power-assisted, or ultrasound-assisted), nipple-conserving subcutaneous mastectomies, or nipple transpositions via various techniques. Unsightly scarring, with visible scar hypertrophy and nipple necrosis, continues to plague postoperative cosmetic outcomes;hence, different techniques of performing nipple transposition have been devised, ranging from free grafts to pedicled flaps. In this case report,we draw attention to an old technique, described by Passot in 1925, that was applied primarily for reduction mammoplasty in women at that time. This technique is still not as frequently used as the Wise pattern mastopexy technique in gynecomastia surgery, and we wish to convey that better cosmesis would be achieved in patients with Simon ⅡB/Ⅲ and ptotic gynecomastia using this technique, avoiding a vertical scar.

Dermatomal Somatosensory Evoked Potentials: An Indicator of Improvement of Breast Sensibility after Reduction Mammaplasty

Introduction: Many women think about reduction mammaplasty for different reasons. The effect of surgery on the beast sensibility is one of the greatest concerns after reconstructive reductive breast surgery through its affect on patient’s social life and psychological health. The dermatomal somatosensory evoked potential (D-SEP) is a new method to quantitatively evaluate breast sensibility. Patients and Methods: Twenty-five women enrolled in this study presenting with breast enlargement, underwent mammary reduction by using the inferior pyramidal breast reduction technique using the same operative technique described by Robbins with some modifications. All D-SEP amplitudes and latencies were calculated preoperatively and then were reassessed six and twelve months post-surgery in each breast. Result: The results revealed that there is a significant difference in the D-SEP latency pre- and post-operatively. The statistically significant decrease in latency and the breast size demonstrated indicates that the sensibility improved after breast reduction surgery both at six and twelve months. There is also a significant increase in the D-SEP amplitude pre- and post-operatively. The negative and statistically significant increase in amplitude with the decrease in breast size demonstrated indicates that the sensibility improved after breast reduction surgery both at six and twelve months. Conclusion: This study concluded that breast sensibility will improve after breast reduction as indicated by significant reduction of D-SEP latencies and increase of its amplitudes. Our results confirm an inverse relationship between breast size and sensibility, with improvement in sensibility after breast reduction.

Operative Technique for Correction of Gigantomastia,Using the Superior Pedicle,with Special Care for the Nipple-Papillary Grafts:A 13-Year Retrospective Study

This is a retrospective study on gigantomastia correction in obesity facing the technique of nipple-areolar grafts and its complexity. The main question is the technical-surgical care during its execution aiming to achieve reparative results that can return to these women the desire to live with better quality of life and health. Method: We performed a retrospective study of all obese patients with severe gigantomastia who underwent reduction mammaplasty with an operative technique using the superior pedicle, with special care for the nipple-papillary grafts. The study was carried out at a single institution between 2001 and 2013, in a total of 30 cases. This operative technique was presented at first time in 1980, with no changes up to now. We emphasized the perfect decortication of the areola and nipples until they were translucent after the maneuvers of Schwartzman and subsequent grafts operated in both breasts. Results: Results were considered satisfactory, from the reparative and aesthetic point of view, emphasizing the degree of improvement observed in women undergoing technique. Discussion: We can say that during all this time of aesthetic and therapeutic-restorative surgery, due to its realization in a single surgical time, there was big impact on the aesthetics of patients and on their families, even taking into account possible complications in the post-operative. Conclusion: The superior pedicle technique, performed as described here, is a safe and reliable procedure in patients with severe gigantomastia.

A simple classification and a simplified treatment's algorithm for ptotic breasts

Aim: Many classifications have been described in the literature for ptotic breasts, focusing on the nipple areola complex position compared to the inframammary fold. These use centimeters and lateral views to illustrate their various grades in a manner always insufficient to propose a clear treatment plan aimed at achieving natural results. We discuss a new dynamic approach to breast ptosis with a complete treatment algorithm. Methods: Patients were examined in a standing position first with hands down then with hands up. We observed the elevation of the inter-nipple line called the 'BK-line' and its relationship to a sternal benchmark that we call the 'BK-Point'. The 'hands-up test' was positive when the line crossed the landmark. The algorithm defines the indication according to this clinical examination and to the patient's wishes. An angle between the nipple, the 'BK-point' and the body meridian (called the 'BK angle') was appreciated before and after surgery. This angle should become 90° or more after ptosis treatment. Results: Three hundred patients were treated for ptotic breasts, including breast reductions, from January 2010 to September 2017. The definitions of 'normal' non-ptotic and ptotic breast and the 'ideal' breast were reconsidered. The surgical indications were adjusted to the clinical situation and to the patient's wishes, refining the final version of the algorithm. Conclusion: This new classification is easy, reproducible and efficient. We propose an appropriate algorithm to treat every situation that takes care to consider patient's wishes and expectations.

Inferior dermoglandular flap for autologous breast remodeling following explantation of breast implants in ptotic breasts:a case report and literature search

Explantation following aesthetic mammoplasty without implant replacement is quite uncommon and often leaves the patient worse off than prior to mammoplasty.A case is presented here in which patient’s own tissue was used as an inferior dermoglandular flap for autologous breast remodeling.Inferior dermal flap has been described for breast reconstruction and simultaneous augmentation mammoplasty with mastopexy for prosthesis cover in the lower pole of the breast,but its use following explantation without implant replacement has not been described for breast remodeling and volume conservation.

A propensity score matched analysis of obesity as an independent risk factor for postoperative complications in reduction mammaplasty

Aim:Reduction mammaplasty is a commonly performed procedure for the treatment of symptomatic macromastia and is increasingly desired by the obese population.With the increasing prevalence obesity in the population,it is imperative to understand its effect on postoperative outcomes.The purpose of this study is to evaluate obesity as an independent risk factor for postoperative complications in breast reduction surgery using 1:1 patient matching through propensity scores between obese patients and non-obese controls.Methods:Between 2005 and 2013,the National Surgical Quality Improvement Program dataset identified a total of 6,016 patients as having undergone primary reduction mammaplasty with 30-day postoperative follow-up.Patients were divided into obese[body mass index(BMI)of 30 or more]vs.not obese(BMI below 30).Patients were initially analyzed using standard multivariable analysis.Using propensity scores obtained from a logistic regression model,patients were subsequently matched 1:1 according to preoperative and operative variables to truly isolate the effect of obesity on surgical outcomes.Outcomes were compared between the matched cohorts using McNemar’s test and the Wilcoxon signed rank test.Results:In unmatched multivariable analysis,rates of overall complications(7.2%vs.5.3%,P=0.0024),wound complications(5.5%vs.3.6%,P=0.0004),superficial surgical site infection(4.1%vs.2.8%,P=0.0050),and wound dehiscence(0.3%vs.1.1%,P=0.0005)were found to be statistically different between obese vs.non-obese,respectively.However,when comparing 1:1 matched obese and non-obese patients,only wound complications(4.6%vs.3.1%,P=0.0334)were significantly increased in the obese cohort.Conclusion:Using the most robust statistical tools available,obesity was determined to affect wound complications after breast reduction without increased detriment on other major complications when compared to the non-obese.Obesity should be a considered with other preoperative comorbidities,rather than an independent contraindication to surgery.Breast reduction appears to be safe in the obese patient who is otherwise healthy.

A long term review of augmentation mastopexy in muscle splitting biplane

Aim:Simultaneous or single stage mastopexy with augmentation is challenging,unique and commonly performed by a plastic surgeon.In this procedure pocket for implant placement,marking for envelope reduction and type of implants used can affect the outcome of the procedure.Muscle splitting pocket for mastopexy is a plane described by the author for implant placement with a short term follow up.The use and outcome of the technique is presented with a larger series and a long term follows up to evaluate the efficacy of the procedure.Methods:Retrospective data was collected.Augmentation was performed using muscle splitting technique and periareolar,vertical scar and wise pattern were used for skin reduction and mastopexy.A single surgeon performed all procedures.Results:In total 108 patients mastopexy with augmentation in muscle splitting technique.The mean age of the patient was 32.2 years(range:18-67 years)with an average follow up of 4.5 years(range:3 months to 10 years).All patients had round textured cohesive gel silicone implants with a mean size of 308 cc(range:200-555 cc).Wound infection was seen in 4(3.7%),wound breakdown in 7(6.5%)patients.Drains were used in 25(23.1%).All patients were treated as day cases and revision surgery was performed in 12(11.1%).There was no hematoma,deep venous thrombosis(DVT)or nipple areolar complex in the series.Conclusion:Simultaneous augmentation mastopexy in muscle splitting pocket can be performed with good aesthetic results along with an acceptable revision rate.