title: Secondary mastopexy in the augmented patient: a recipe for disaster.
abstract: BACKGROUND
  Augmentation mammaplasty is popular procedure, but one that is associated with a relatively high rate of revisionary surgery. Over time, the augmented breast frequently becomes ptotic and patients may return requesting mastopexy. Experience has shown that secondary mastopexy in the augmented breast is fraught with potential complications, including fat necrosis, skin flap loss, and nipple ischemia.
  
  
  METHODS
  Factors that contribute to increased morbidity when mastopexy is performed in the previously augmented breast are analyzed; the surgical options available for correcting ptosis in these cases are systematically reviewed.
  
  
  RESULTS
  The long-term presence of implants typically results in changes in breast anatomy and physiology, including parenchymal atrophy, tissue thinning, and diminished skin blood supply. These factors greatly increase the surgical risks of secondary mastopexy.
  
  
  CONCLUSIONS
  When planning and executing mastopexy in the previously augmented patient, the plastic surgeon must carefully consider the potential adverse effect of implants on the blood supply to the breast. With thoughtful planning and cautious operative technique, good results can be achieved in most cases, and the risk of serious complications can be minimized.
authors.affiliation: Division of Plastic Surgery, University of California, Los Angeles School of Medicine, Santa Barbara, CA, USA. drhandel@aol.com
authors.forename: Neal
authors.initials: N
authors.lastname: Handel
mesh_terms: D000328:Adult; D018427:Breast Implants / Q000009:adverse effects; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation