Preservation Augmentation Mastopexy (Posterior Lamella-Preserving Technique): Posterior Lamella of the Superficial Fascial System for Lower Pole Reinforcement.

BACKGROUND

Simultaneous augmentation mastopexy is technically demanding due to challenges in maintaining durable lower-pole support and preventing implant malposition, wound dehiscence, and exposure. Reinforcement methods such as dermoglandular flaps, dermal slings, and acellular dermal matrices (ADMs) add cost, complexity, or morbidity. This study evaluates Preservation Augmentation Mastopexy, a technique that preserves the posterior lamella of the superficial fascial system to reinforce the lower pole.

METHODS

A retrospective review was performed of 45 consecutive patients who underwent primary augmentation mastopexy with posterior lamella preservation between February 2020 and January 2024. All procedures were carried out using an inverted-T incision and a superior-pedicle technique. The posterior lamella was preserved as a vascularized flap above the implant and anchored to the inframammary fold. Patient demographics, implant characteristics, complications, and patient-reported outcomes were analyzed, with a mean follow-up of 21.5 ± 9.5 months (median, 18 months; range, 12-38 months). All patients were followed for a minimum of 12 months.

RESULTS

Three minor complications (6.7%) were recorded: one late-onset infection, one seroma with partial wound dehiscence, and one isolated wound dehiscence. All were managed conservatively without implant removal or revision. No cases of implant malposition, bottoming out, or implant exposure were observed. BREAST-Q analysis demonstrated significant postoperative improvements in all domains, including satisfaction with breasts (+30.4%, p < 0.001), psychosocial well-being (+16.4%, p < 0.001), sexual well-being (+26.8%, p < 0.001), and physical well-being (+11.4%, p < 0.001). Subgroup analysis showed consistent improvements regardless of implant pocket plane.

CONCLUSIONS

Preservation of the posterior lamella provides a simple, biologically integrated, and cost-effective method for reinforcing the lower pole in augmentation mastopexy. By stabilizing the inframammary fold and providing reliable implant coverage, this technique may reduce the risk of implant descent and exposure while avoiding synthetic meshes or bulky autologous flaps. Larger prospective studies are warranted to validate long-term outcomes and broader applicability.

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