Extended Superior Pedicle Autoaugmentation (ESPA) Mastopexy: A Review of 20 Consecutive Patients.

Background: Ptotic breast deformity arises from decreased breast tissue volume and skin laxity, causing descent of breast tissue due to gravity. Mastopexy lifts and reshapes the breast and can be potentially associated with breast implants in case of need of volume increase. However, this option is not accepted by all the patients. The extended autoaugmentation mastopexy (ESPA) incorporates an abdominal flap to increase breast volume without implants, reducing surgical time and offering stable long-term outcomes.

Objectives: The authors propose modifying the superior pedicle vertical mammaplasty to include glandular tissue transposition and an abdominal flap. This aims to restore central mound projection, narrow the lower breast base, and raise the inframammary fold.

Method: Twenty patients underwent superior pedicle extended autoaugmentation (ESPA) mammaplasty from 2020 to 2024. Patients, aged 25 to 45, with wide, low-lying breasts lacking central projection, were selected. Breast tissue was elevated on a superior dermal pedicle extended inferiorly to an abdominal flap and transposed into a prepectoral pocket. The inframammary fold was raised, and the dead space is closed using internal and external temporary sutures.

Results: Patients tolerated well the procedure, with one developing a seroma, successfully managed. All 20 patients expressed high satisfaction with postoperative breast shape and size, with no desire for subsequent augmentation.

Conclusions: The technique extends the superior pedicle to include abdominal tissue, restoring central mound projection and modifying the inframammary fold. It reliably recreates a more youthful breast shape in suitable patients without the need for implants.

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