Safety of vertical augmentation-mastopexy: prospective evaluation of breast perfusion using laser fluorescence imaging.

BACKGROUND Augmentation-mastopexy is often recommended to simultaneously correct breast ptosis and restore upper pole fullness. However, some investigators believe that this procedural combination increases risk and recommend staging the surgery for some patients. OBJECTIVES This prospective study was undertaken to evaluate the blood supply of the breast and, specifically, the nipples and areolae to determine whether breast implants inserted at the time of a vertical mastopexy compromise blood supply. METHODS The SPY Elite Intraoperative Perfusion Assessment System was used to provide objective measurements of skin perfusion during surgery. To avoid confounding variables, patients served as their own controls. Twenty-five women (50 breasts) meeting the inclusion criteria (inclusion rate: 96%) were studied. All patients underwent bilateral vertical augmentation-mastopexies using a medial pedicle. No surgery was staged. The mean implant volume was 360 cc (range, 180-575 cc). The breasts were imaged in surgery after completion of bilateral mastopexies with insertion of (unfilled) saline breast implants and a second time after inflation of the implants. RESULTS Complications included 1 distal deep venous thrombosis, 1 infection, 1 partial areola necrosis, and 1 case of delayed wound healing. There was no significant difference (P < .01) in intraoperative perfusion measurements comparing absolute and relative values before and after breast implant inflation (saline-filled implants) or insertion (silicone gel implants), including 5 patients undergoing secondary mastopexies. CONCLUSIONS The insertion of breast implants at the time of a vertical mammaplasty with a medial pedicle does not significantly reduce perfusion of nipple/areola complexes. Staging the procedure is unnecessary. LEVEL OF EVIDENCE 4 Therapeutic.