Most cases of breast ptosis occur after childbirth. Other cases may be congenital or result from improper breast care, the habit of not wearing a supportive bra even during sports activities, aging, excessive weight loss, and other factors. Depending on their needs, patients may choose mastopexy with or without implant placement. Based on the amount of breast glandular tissue, the degree of skin laxity, and the patient’s goals, the surgeon will develop a suitable surgical method for mastopexy.
The mastopexy solution uses an ultrasonic scalpel combined with a glandular tissue-preserving mastopexy technique, helping lift and reconstruct a compact breast shape WITHOUT THE NEED FOR BREAST IMPLANTS.
Video on the treatment protocol for breast ptosis:
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COMPLICATIONS IN MASTOPEXY COMBINED WITH BREAST IMPLANT PLACEMENT
Most patients with grade 3 or grade 4 breast ptosis are commonly indicated for inverted-T mastopexy combined with breast implant placement. Although this is a conventional solution for severe breast ptosis, the method carries many risks of complex postoperative complications, such as ischemia leading to necrosis of the nipple-areola complex, poor wound-edge perfusion resulting in unfavorable contracted scars, or loss of breast shape and recurrent ptosis over time.
In revision surgeries aimed at correcting and revising breast shape after previous mastopexy with implant placement, the surgeon must face the following challenges and difficulties:
1. Effects of Fibrotic Scar Tissue on Elasticity and Blood Supply
The presence of fibrotic scar tissue from previous surgeries significantly reduces the natural elasticity and uniform stretch-and-recoil behavior of the skin and subcutaneous tissue. This condition not only makes dissection and breast shape correction more difficult, but also increases the risk of localized ischemia. As a result, it can easily lead to tissue fibrosis, poor wound-edge perfusion, and tissue necrosis during revision surgery.
2. Challenges in Redistributing the Position of Breast Glandular Tissue
Breast glandular tissue is naturally distributed in different volumes and positions across the breast, depending on each patient’s age and childbirth history. In previous major mastopexy surgeries, if the glandular tissue was excised unevenly, excessively, or repositioned asymmetrically, a second corrective procedure will present significant challenges. The point dissection technique used to redistribute and rearrange the volume of glandular tissue evenly during the second surgery becomes extremely complex.
3. Risk of Injury to the Vascular Supply
The dense vascular network interwoven throughout the breast glandular tissue plays a central role in supplying oxygen-rich blood and nutrients to maintain the viability of the entire breast tissue. In surgery to treat recurrent breast ptosis, the surgeon must be extremely careful when repositioning the glandular tissue and the nipple-areola complex to a higher position.
The surgeon must perform precise dissection to preserve the key vascular pedicles, thereby preventing ischemic necrosis, a complication that is particularly likely to occur in patients who already have extensive fibrotic scar tissue. Excessively thick glandular tissue or tissue affected by fibrotic adhesions from old scars increases the complexity of the surgery, requiring the surgeon to possess advanced technical skills and extensive experience in designing and preserving the vascular pedicles that supply the areola and nipple.
Before deciding to undergo aesthetic intervention, patients should proactively examine the condition of their breasts, clearly identify their expectations, and discuss them with the surgeon to select the most appropriate surgical method. Selecting the correct technique from the beginning is a key factor in preventing recurrent breast ptosis and avoiding the need for a second, third, or subsequent reconstructive surgery, which can seriously affect health and result in additional costs.
GUIDELINES FOR SELF-ASSESSING THE DEGREE OF BREAST PTOSIS
1. For Grade 1 and Grade 2 Breast Ptosis
Self-assessment method: The patient should stand in front of a mirror with both arms relaxed, without wearing a bra, and look straight ahead. If the nipple is level with or 1–2 cm below the inframammary fold, this is a sign of grade 1 or grade 2 breast ptosis.
Recommended solution: At this degree, Dr. Ho Cao Vu recommends that patients choose breast implant placement alone, without any additional excisional mastopexy procedure. By applying the modern Dual Plane II implant pocket creation technique, this method helps improve projection and increase breast volume while thoroughly correcting mild breast ptosis, resulting in a naturally full and rounded breast shape.
2. For Grade 3 and Grade 4 Breast Ptosis
At this severe degree of ptosis, patients need to carefully assess the current amount of glandular tissue, skin elasticity, and the degree of stretch marks. These stretch marks appear when the skin is excessively stretched after childbirth, causing collagen and elastin fibers to break. Depending on each individual’s biometric characteristics, the treatment options are classified as follows:
In cases of hypertrophic glandular tissue, loose skin, loss of elasticity, and numerous stretch marks: These patients have a body condition that is prone to recurrent breast ptosis due to poor skin-supporting quality. For those who wish to correct breast ptosis thoroughly and safely in the long term, Dr. Ho Cao Vu recommends choosing mastopexy with preservation of breast glandular tissue, without breast implant placement. Avoiding implants helps reduce gravitational pressure on skin that is already weakened, thereby maintaining long-lasting results and preventing complications such as loss of breast shape or recurrent postoperative ptosis.
In cases with a small amount of glandular tissue, good skin elasticity, and grade 3 breast ptosis along the vertical axis: The surgeon recommends breast implant placement combined with areolar reduction. However, to ensure maximum aesthetic safety, this procedure should be divided into two separate surgeries performed at an appropriate interval. Separating the procedure into two stages allows the breast pocket and skin time to adapt, avoids excessive tension on the periareolar incision, and thereby eliminates the risk of skin-edge necrosis and unfavorable scar formation. Patients may flexibly choose to undergo breast implant placement first to assess the degree of natural lifting achieved by the tissue, followed by a minor areolar reduction procedure, or vice versa.
Many cases of recurrent breast ptosis no longer have healthy skin, have hardened fibrotic tissue, excessive loss of breast glandular tissue volume, and imbalance of the nipple-areola complex in terms of both position and size. The length and position of scars from the previous surgery also create difficulties for subsequent reconstructive treatment. Recurrent breast ptosis refers to the condition in which breast ptosis recurs after aesthetic breast surgery. The main cause of “recurrent breast ptosis” is the inaccurate selection of the surgical method for the patient.
“Recurrent breast ptosis can easily leave scars, cause a lack of breast tissue and skin for mastopexy with implants, and create difficulties in redistributing the position of breast glandular tissue” – Dr. Ho Cao Vu shared regarding the challenges involved in treating recurrent breast ptosis.
– Insufficient breast tissue and skin for mastopexy with implants: Breast ptosis involves excess skin and may also be accompanied by excess glandular tissue. Therefore, mastopexy procedures generally involve excising excess glandular tissue and skin, with or without implant placement depending on the surgeon’s indication and the patient’s goals. However, when the surgeon excises too much glandular tissue and excess skin during the initial surgery, if the patient is dissatisfied with the aesthetic result or develops recurrent breast ptosis, subsequent reconstructive surgery will be extremely difficult for the surgeons. In the worst-case scenario, the patient may no longer be able to receive breast implants.
– Scarring: Unfavorable scars, hypertrophic scars, contracted scars, excessively widened scars extending across the breast mound, and excessively long unfavorable scars extending beyond the inframammary fold are common in mastopexy. There are many causes, including insufficient blood supply, bleeding, excessive fluid accumulation within closed pockets, infection, inappropriate breast implant selection, wearing the postoperative compression bra with improper lift/support and compressive pressure that creates excessive tension on the incision, and the use of an electrosurgical device that causes tissue damage over a wide area and affects the wound-healing process.
Depending on the degree, location, extent of widening, scar age (mature or immature scars), pigmentation, and scar characteristics, the surgeon must conduct an examination and develop a treatment protocol for recurrent breast ptosis that ensures both safety and aesthetic outcomes.
In cases involving extensively widened scars and hard, poorly elastic fibrotic scar tissue, the surgeon will face many difficulties during scar excision and reconstruction to create a finer, more aesthetically pleasing scar.
CHALLENGES AND DIFFICULTIES IN TREATING COMPLICATIONS OF RECURRENT BREAST PTOSIS
Recurrent breast ptosis refers to the condition in which breast ptosis recurs after previously undergoing aesthetic mastopexy. According to Dr. Ho Cao Vu, the root cause of recurrent breast ptosis mainly stems from the surgeon’s inaccurate selection of the surgical method. Many clinical cases have recorded extremely severe complications of recurrent breast ptosis: no remaining healthy skin foundation, hardened fibrotic tissue, excessive loss of breast glandular tissue volume, severe imbalance of the nipple-areola complex in both position and size, together with an extensive network of old scars. All of these factors create an extremely difficult problem for the surgeon in performing reconstructive treatment during subsequent surgeries.
In particular, Dr. Ho Cao Vu has identified the core difficulties in the process of managing recurrent breast ptosis, including:
1. Severe Deficiency of Breast Tissue and Skin for Breast Mastopexy with Implant Placement
The nature of the initial surgery to treat breast ptosis is to remove excess skin and hypertrophic glandular tissue. However, if the surgeon excises an excessive amount of glandular tissue and excess skin during the first surgery, the resulting consequences are extremely complex.
When the patient is dissatisfied with the aesthetic result or experiences complications of recurrent breast ptosis, the remaining tissue and skin foundation will be severely deficient, making the redistribution of breast glandular tissue during the subsequent surgery very difficult. In the worst-case scenario, because there is no longer sufficient skin coverage and supporting tissue to protect the implant, the patient will completely lose the opportunity to receive breast implants to increase breast volume.
2. Challenges from a Complex and Extensive System of Old Scars
Unfavorable scars, hypertrophic scars, contracted scars, excessively widened scar lines spreading across the breast mound, or scars extending beyond the inframammary fold are very common deforming complications after mastopexy.
These unfavorable scars result from various clinical causes:
• Insufficient blood supply to the skin flap, bleeding and bruising, or extensive fluid accumulation within closed pockets, causing surgical site infection.
• Selection of an inappropriate breast implant size that is too heavy, or wearing the postoperative compression bra with incorrect pressure and excessive compression, creating continuous tension on the suture line.
• The use of a conventional electrosurgical device that generates excessively high heat, causing deep burns and widespread tissue damage and delaying the natural wound-healing process.
To manage these conditions effectively, the surgeon must directly examine the patient and carefully assess the degree, location, extent of scar widening, scar age (whether the scar is mature or immature), skin pigmentation, and the biological characteristics of the fibrous tissue in order to develop a comprehensive treatment protocol for recurrent breast ptosis. In cases where the old scars have spread extensively and the hardened fibrous tissue has completely lost its elasticity, the process of dissecting and excising the old scars to reconstruct a new, fine, and aesthetically pleasing scar will require extremely delicate and precise technique from the surgeon’s hands.
IMAGES OF MASTOPEXY WITHOUT IMPLANTS USING A NEW-GENERATION ULTRASONIC SCALPEL
ADVANTAGES OF THE ULTRASONIC SCALPEL IN MASTOPEXY
Dr. Ho Cao Vu stated that, during mastopexy, particular attention must be paid to the fascial layer between the anterior surface of the breast gland and the pectoralis major muscle, where there are many small, colorless lymphatic vessels that are difficult to see. Therefore, the Harmonic scalpel, with its sealing function that provides immediate hemostasis, helps limit tissue damage and is beneficial in subglandular breast augmentation by preserving the fascial layer.
MD, MSc. Ho Cao Vu uses a new-generation ultrasonic scalpel to resect glandular tissue during mastopexy.
Using a new-generation ultrasonic scalpel with coagulation, sealing, and cutting functions in mastopexy offers many advantages when excising fatty tissue and breast glandular tissue and releasing the necessary tissues. After surgery, patients experience no pain and almost no swelling or bruising; no drainage tube is required; patients can be discharged after only 6–8 hours; and patients can return to work and normal light daily activities after one day. In particular, this method minimizes the risk of undergoing repeated surgeries, thereby avoiding pain and adverse effects on health.
Wound closure after mastopexy without implants
