Mastopexy for breast ptosis: Utility outcomes of population preferences.

Several factors can contribute to diminished elasticity of the breast over time, which, in turn, can result in breast ptosis. True ptosis occurs when the nipple-areola complex is below the level of the infra-mammary fold (1). Mastopexy is a procedure performed to modify the size, contour and elevation of sagging breasts without changing breast volume (2,3). Its goal is to restore a natural and youthful appearance to the breast that can either be performed as a standalone breast lift procedure, or in combination with breast augmentation or reduction mammoplasty (1,4,5). Mastopexy has traditionally used skin excision techniques including crescent, periareolar and inverted T designs to tighten the skin brassiere and elevate the nipple-areola complex; however, there is now emphasis being placed on internal shaping of the parenchyma (1,3,6–12). Depending on the degree of breast ptosis and according to Regnault’s classification, the type of mastopexy performed can be determined (3,13). A major drawback of this procedure is that it can leave an unattractive scar; as such, trading a sagging breast for a breast that is visibly scarred can present a dilemma (1). Other common complications associated with this procedure include nipple asymmetry, nipple necrosis, fat necrosis and skin necrosis (14). Furthermore, following glandular reshaping, microcalcifications can appear on mammography that, fortunately, can be distinguished from malignancy (3). In mild to moderate ptosis, the limited scar mastopexy technique can be implemented with excellent outcomes. However, in severe cases, a Wise pattern breast reduction is the most feasible option and produces reliable results (15,16). The most common type of mastopexy performed by plastic surgeons in the United States is skin excision involving the inverted T incision; however, this is reportedly most prone to developing ‘bottoming out’. Short-scar circumvertical incisions result in the highest physician satisfaction but the largest number of cases of asymmetry, and periareolar incisions produce the greatest rate of return to the operating room for a revision procedure (3,17). To gain more knowledge on the health burden of living with breast ptosis requiring mastopexy, validated measures can be used to compare it with other health states. The most commonly used tools for utility assessment in outcomes research include the visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods. They are used together to reduce the possibility of fault from any single measure (18–20). The utility scores ascertained using these tools are translated into a numerical value ranging from 0 (death) to 1 (perfect health) using a special algorithm (21–26). These tools have been used previously to assess outcomes for many different conditions (21,23–33). The VAS involves visualizing being in the given health state and providing a numerical score from 0 (death) to 1 (perfect health). TTO examines willingness to either trade years of life to live in perfect health (in this case, by undergoing a mastopexy procedure) or to live a set number of years in the described health state (breast ptosis). Similarly, SG provides a choice between either gambling with a degree of success (undergoing a mastopexy procedure) to attain perfect health or failure, or choosing to stay in the current health state (breast ptosis) (18,34,35). Not only can utility outcome scores aid in the comparison of the health burden of living with different conditions, but they can also be used in cost-effectiveness analysis and proper resource allocation, as well as the surgical decision-making process (26,28,36). The goal of the present study was to quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure and to determine whether utility scores vary according to participant demographics.