Systematic review of outcomes and complications in nonimplant-based mastopexy surgery

Summary Background Mastopexy is one of the most performed cosmetic surgery procedures in the U.S. Numerous studies on mastopexy techniques have been published in the past decades, including case reports, retrospective reviews, and prospective studies. However, to date, no study has investigated the overall complications or satisfaction rates associated with the wide spectrum of techniques. Objectives This review aims to assess the outcomes of the various mastopexy techniques, without the use of implants, thus focusing on associated complications, and to provide a simplified classification system. Methods This systematic review was performed in accordance with the PRISMA guidelines. PubMed database was queried in search of clinical studies describing nonprosthetic mastopexy techniques, which reported the technique, indication, and outcomes. Results Thirty-four studies, published from 1980 through 2016, were included and represented 1888 treated patients. Four main surgical technique categories were identified: dermal reshape, glandular reshape, glandular reshape associated with perforator flaps, and glandular reshape with mesh support. Despite varying techniques, mastopexy was generally found to be a reliable esthetic procedure with unsatisfactory breast shape, thus accounting for only 1.3% of the patients. The overall complication rate was 10.4%. The most represented complications were scar-related (3%, including hypertrophic or unesthetic appearance) and nipple–areola-related problems (2.9%; including distortion, asymmetry, and reduction in sensation). Conclusions Mastopexy techniques achieve high patient satisfaction and can be tailored according to patient needs and clinical presentation. Complication rates and morbidity are relatively low. However, a significant number of issues related to scars, asymmetry, and potential ptosis recurrence should be highlighted in the information provided to patients.