title: Augmentation mastopexy: maximal reduction and stable implant coverage using four flaps.
abstract: BACKGROUND
  A single-stage operation to correct ptotic and hypoplastic breasts would appear to be a very appealing option for both surgeons and patients. However, this procedure is the most often litigated in aesthetic surgery because of its frequent complications. Our goal in this article is to report our experience with a four-flap technique for implant coverage in maximum reduction mastopexy with prosthesis.
  
  
  METHODS
  From January 2011 to March 2013, a total of 41 patients with Regnault grade II or grade III ptosis with no hypertrophy underwent primary bilateral augmentation mastopexy. Our technique includes an inverted-T mastopexy and a thin, well-vascularized, inferior dermoglandular flap to cover the inferior pole of the implant. Retrospective data collection revealed a mean patient age of 37.5 years. Thirty-nine patients were treated with round cohesive silicone gel implants and two with anatomical cohesive gel implants. The mean implant volume was 280 cc and mean follow-up time was 14 months.
  
  
  RESULTS
  The following complications were observed in declining frequency: four suture dehiscences, two hematomas, one capsular contracture, one implant malposition, and one poor scarring. A satisfaction questionnaire revealed very high satisfaction in 23 patients (56.09 %), high satisfaction in 12 (29.26 %), moderate satisfaction in four (9.75 %), and low satisfaction in two (4.87 %).
  
  
  CONCLUSIONS
  Our results demonstrated a low complication rate (21.9 %) and low reoperation rate (12.1 %) with our technique and make us confident in recommending this technique for grade II and grade III ptosis.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .
authors.affiliation: Private Practice, Av Reina Victoria Nº17, 7ºa, 28003, Madrid, Spain, eduformel@hotmail.com.
authors.forename: Eduardo Melero
authors.initials: EM
authors.lastname: Forcada
authors.forename: Miguel Calderón
authors.initials: MC
authors.lastname: Fernández
authors.forename: Jorge Vizán
authors.initials: JV
authors.lastname: Aso
authors.forename: Israel Pena
authors.initials: IP
authors.lastname: Iglesias
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D013524:Surgical Flaps