Septum-Based Augmentation Mastopexy for Moderate to Severe Ptosis in Medium-to-Large Breasts: A Retrospective Cohort Study.

Abstract

Augmentation mastopexy is complex due to the biomechanical conflict between lifting ptotic tissue and introducing volume with implants. In medium-to-large breasts or in patients with poor tissue quality, the imbalance between native parenchyma and implant weight may lead to recurrent ptosis, bottoming-out, and aesthetic dissatisfaction. Clinical outcomes and patient satisfaction following a septum-based parenchymal reduction technique combined with dual-plane augmentation were investigated. We conducted a retrospective review of a multicenter database including 238 patients who underwent bilateral septum-based augmentation mastopexy (January 2018 - May 2023). Inclusion criteria were age ≥18 years, Regnault grade II-III ptosis, and follow-up ≥12 months. The technique involved wide parenchymal resection on a vascularized medial pedicle including the internal septum, followed by dual-plane implant placement. Patient-reported outcomes were assessed (BREAST-Q Augmentation and Reduction/Mastopexy modules) preoperatively and at 30 days, 6 and 12 months. Rasch-transformed scores were analyzed using Wilcoxon signed-rank tests (p<0.05). Mean patient age was 35.2 years; mean BMI was 23.6kg/m2. Average implant volume was 345.1cc. Statistically significant improvements (p < 0.05) were observed in all BREAST-Q domains. Overall complication rate was 11.3% (reoperation rate 5.9%). Recurrent ptosis occurred in 1.3%. No BIA-ALCL cases were reported. Septum-based augmentation mastopexy appears safe and reliable in moderate to severe ptosis, especially in medium-to-large breasts. The technique allows controlled tissue reduction, maintains vascularity, and improves implant integration. Patient satisfaction and complication rates are favorable compared to the literature. However, further prospective studies are needed to confirm long-term stability and refine patient selection criteria.