Enhancing aesthetic and functional outcomes in mastopexy: A modified Pitanguy-Ribeiro technique

  • Received 15.08.2024

  • Revised 02.01.2025

  • Accepted 25.02.2025



  • 1,018 Views

  • Retrieved from Vol. 7, No. 1, 2025

  • Pages 26-32

One of the unresolved issues in aesthetic mammoplasty remains the prevention of gravitational ptosis in the long-term postoperative period. The aim of this study was to improve the outcomes of mastoptosis treatment by refining classical surgical techniques to help prevent recurrent ptosis in the long term. The main group consisted of 50 patients diagnosed with mastoptosis. These patients underwent surgery using a modified Pitanguy-Ribeiro method, which included fixation to reduce cranial displacement and anchoring to the fascia of the pectoralis major muscle. The study results highlight the importance of individually selecting mastopexy techniques for each patient to achieve sustained aesthetic and functional outcomes. This paper presents the distribution of patients according to the mastopexy technique used, as well as a comparison of early and late postoperative ptosis indicators across each group. It was found that mastopexy performed using the Pitanguy-Ribeiro technique is effective in the short term but carries a significant risk of late postoperative ptosis. Reduction mastopexy shows a high risk of ptosis in the long-term postoperative period. In contrast, the modified Pitanguy-Ribeiro technique proves to be an effective approach, offering more stable results compared to the other techniques considered in preventing postoperative ptosis – demonstrated by the complete absence of early ptosis and the lowest incidence of late ptosis, indicating its superiority. This study identifies the modified Pitanguy-Ribeiro technique as the most effective for mastopexy correction, ensuring long-term stability, prevention of ptosis recurrence, and a high level of patient satisfaction. The proposed modification can be recommended as the optimal technique for performing mastopexy. The study findings may be used to refine surgical techniques, support the development of personalised recommendations for mastopexy method selection, and inform planning of long-term postoperative preventive measures

breast ptosis; surgical correction; fascia fixation; aesthetic mammoplasty

https://doi.org/10.63341/bmbr/1.2025.26

[1] Khrapach OV. Types of postoperative aesthetic complications after breast endoprosthetics (review of the leading researches). Med Sci Ukr (MSU). 2024;20(4):126–36. DOI: 10.32345/2664-4738.4.2024.14 

[2] Atiyeh B, Ghieh F, Chahine F, Oneisi A. Ptosis and bottoming out following mastopexy and reduction mammoplasty. Is synthetic mesh internal breast support the solution? A systematic review of the literature. Aesth Plast Surg. 2022;46(1):25–34. DOI: 10.1007/s00266-021-02398-x

[3] Pazhoohi F, Garza R, Kingstone A. Effects of breast size, intermammary cleft distance (cleavage) and ptosis on perceived attractiveness, health, fertility and age: Do life history, self-perceived mate value and sexism attitude play a role? Adapt Hum Behav Physiol. 2020;6:75–92. DOI: 10.1007/s40750-020-00129-1

[4] Pearlman RL, Wilkerson AH, Cobb EK, Morrissette S, Lawson FG, Mockbee CS, et al. Factors associated with likelihood to undergo cosmetic surgical procedures among young adults in the United States: A narrative review. Clin Cosmet Investig Dermatol. 2022;15:859–77. DOI: 10.2147/CCID.S358573

[5] Lee SJ, Han WY, Eom JS, Kim EK, Han HH. Analysis on the difference between the practical brassiere size and real breast volume. Plast Reconstr Surg Glob Open. 2023;11(8):e5141. DOI: 10.1097/GOX.0000000000005141

[6] Mangialardi ML, Ozil C, Lepage C. One-stage mastopexy-lipofilling after implant removal in cosmetic breast surgery. Aesth Plast Surg. 2022;46(4):1542–50. DOI: 10.1007/s00266-021-02727-0

[7] Hoyos А. Total definer: Atlas of advanced body sculpting. 1st ed. New York: Тhieme Medical Pub; 2022. 514 P.

[8] Ma X, Xu B, Ouyang Y, Du X, Liu C. Preoperative three-dimensional measurement-based periareolar augmentation mastopexy: Indication and breast crown approach. Plast Reconstr Surg. 2022;150(2):310–5. DOI: 10.1097/PRS.0000000000009356

[9] Gunn J, Dortch J, TerKonda S, Schilling K, Li Z, Diehl N, et al. Comparing morbidity rates between wise pattern and standard horizontal elliptical mastectomy incisions in patients undergoing immediate breast reconstruction. Breast J. 2019;25:20–5. DOI: 10.1111/tbj.13150

[10] Nuzzi LC, Firriolo JM, Pike CM, Cerrato FE, DiVasta AD, Labow BI. The effect of surgical treatment on the quality of life of young women with breast asymmetry: A longitudinal, cohort study. Plast Reconstr Surg. 2020;146(4):400–8. DOI: 10.1097/prs.0000000000007149

[11] Regnault P. Breast ptosis: Definition and treatment. Clin Plast Surg. 1976;3(2):193–203.

[12] Khrapach VV. Basics of plastic and reconstructive surgery. Kyiv: Electronic Textbook; 2021. 148 P.

[13] The World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects [Internet]. [cited 2024 August 5]. Available from: https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/

[14] Law of Ukraine No. 2297-VI. On the Protection of Personal Data [Internet]. 2010 June 1 [cited 2024 August 5]. Available from: https://www.president.gov.ua/documents/2297vi-11567

[15] Strombeck JO. Breast reconstruction. I. Reduction mammaplasty. Mod Trends Plast Surg. 1964;16:237–55.

[16] Ribeiro L. A new technique for reduction mammaplasty. Plast Reconstr Surg. 1975;55(3):330–4.

[17] Abdelkader R, Raafat S, Sakr W, Abdelaziz M, ElNoamany S. Augmentation mastopexy: A five-step standardized strategy approach. Plast Reconstr Surg Glob Open. 2022;10(6):e4349. DOI: 10.1097/GOX.0000000000004349

[18] Sá JZ, Santa Cruz Oliveira F, Santinoni WF, Freire A, de Oliveira Rodrigues AE, de Andrade Aguiar JL. Evaluation of the sensitivity of the nipple-areola complex in patients undergoing breast ptosis correction with periareolar dermis release: A randomized controlled trial. Aesth Plast Surg. 2020;44(5):1405–11. DOI: 10.1007/s00266-020-01835-7

[19] Zavrides H. The сlassic Pitanguy technique and its modifications in mammaplasty: Ten years of experiences. Ann Plast Surg. 2017;79(5):433–7. DOI: 10.1097/SAP.0000000000001145

[20] Swanson E. All seasons vertical augmentation mastopexy: A simple algorithm, clinical experience, and patient-reported outcomes. Plast Reconstr Surg Glob Open. 2016;4(12):e1170. DOI: 10.1097/GOX.0000000000001170

[21] Hidalgo DA. Breast augmentation: Choosing the optimal incision, implant, and pocket plane. Plast Reconstr Surg. 2000;105(6):2202–16.

[22] Kostenko AA, Galych SP, Dabizha OY, Samko KA, Borovyk DV. Current state of surgical treatment for patients with tubular breast type II (a literature review). Zaporozhye Med J. 2021;23(1):146–51. DOI: 10.14739/2310-1210.2021.1.224962

[23] Wall S, Wall H, Claiborne JR. Simultaneous short-scar mastopexy augmentation. In: Calobrace MB, Kortesis BG, Bharti G, Mays C, editors. Augmentation Mastopexy. Cham: Springer; 2020. P. 139–55. DOI: 10.1007/978-3-030-48226-8_9

[24] Jian H, Xiao Jun S, Bo T, Xiao Xia L, Xiong Yu Z. A new technique of mastopexy for mastoptosis: With the upturned glandular flap. Int J Transplant Plast Surg. 2019;3(S2):000S2–006. DOI: 10.23880/ijtps-16000S2-006

[25] Moya-Rosa EJ, Moya-Corrales Y. Treatment of the mammary ptosis utilizing the technique of Liacyr Ribeiro type I modified. Rev Arch Med Camagüey. 2019;23(1):28–36.

[26] Ikander P, Sørensen JA, Thomsen JB. Mastopexy with autologous augmentation in women after massive weight loss: A randomized clinical trial. Aesth Plast Surg. 2021;45(1):127–34. DOI: 10.1007/s00266-020-01642-0

[27] Cohen-Shohet R, Bloom J, Mast B. Mastopexy: Current trends in private practice and academic practice and the impact on resident training. Ann Plast Surg. 2020;84(6S):414–16. DOI: 10.1097/SAP.0000000000002273

[28] Di Summa PG, Oranges CM, Watfa W, Sapino G, Keller N, Tay SK, et al. Systematic review of outcomes and complications in nonimplant-based mastopexy surgery. J Plast Reconstr Aesthet Surg (JPRAS). 2019;72(2):243–72. DOI: 10.1016/j.bjps.2018.10.018

[29] Orupabo CD, George OC. Anthropometric variables in breast lesions of women of reproductive age in university of Port Harcourt teaching hospital. Int J Med Med Res (IJMMR). 2022;8(2):18–23. DOI: 10.11603/ijmmr.2413-6077.2022.2.13154