Implant-Compensable Ptosis: A Retrospective Cohort Study Comparing Polyurethane Breast Augmentation Alone Versus Augmentation-mastopexy in Patients with Mild Ptosis.

Abstract

Background: Patients with mild breast ptosis who decline mastopexy pose a clinical challenge. Polyurethane-coated implants possess tissue-adherence properties that may compensate for mild ptosis, but no study has systematically evaluated outcomes in this specific subgroup using defined selection criteria.

Objectives: To evaluate the clinical outcomes of breast augmentation with polyurethane-coated implants without mastopexy in patients with mild ptosis meeting Implant-Compensable Ptosis (ICP) classification criteria, compared to augmentation-mastopexy and augmentation in non-ptotic controls.

Methods: Retrospective three-arm cohort study of 90 consecutive patients (180 breasts) who underwent breast augmentation with polyurethane-coated implants: Group A (ICP, mild ptosis without mastopexy, n = 30), Group B (control, no ptosis, n = 30), and Group C (augmentation-mastopexy, n = 30).

Primary outcome: BREAST-Q Satisfaction with Breasts at 24 months.

Secondary outcomes: compensation failure rate (composite of secondary mastopexy, NAC descent > 2 cm, or BREAST-Q decline ≥ 15 points), operative time, capsular contracture, complications, and patient satisfaction. Non-inferiority was assessed against a 5-point margin.

Results: At 24 months, mean BREAST-Q Satisfaction with Breasts was 75.6 ± 9.5 (Group A), 79.3 ± 11.2 (Group B), and 77.4 ± 9.8 (Group C). The difference between Groups A and C was - 1.8 points (95% CI: - 7.1 to + 3.5; p = 0.494), consistent with non-inferior performance, although formal non-inferiority was not established due to limited statistical power (65% vs. planned 80%). Compensation success rate was 90.3% at 24 months (3 failures: 2 secondary mastopexy, 1 anatomical). Mean operative time was 36 min shorter in Group A versus C (66 vs. 102 min; p < 0.001). No capsular contracture Baker ≥ III occurred in any group. Mean NAC descent at 24 months was 0.82 ± 0.55 cm in Group A, significantly greater than Groups B and C (p < 0.001) but below the 2.0 cm failure threshold.

Conclusions: In patients with mild ptosis meeting ICP criteria, breast augmentation with polyurethane implants alone achieves BREAST-Q satisfaction scores suggestive of non-inferiority to augmentation-mastopexy at 24 months, with a 90% compensation success rate and 35% shorter operative time. Implant volume (≤ 350 cc) emerges as a potential additional criterion. The ICP classification provides the first structured framework for patient selection, counseling, and outcome monitoring in this common clinical scenario. Prospective validation is warranted.

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