A Review of Mammaplasties With Measurements: Evaluating Autoaugmentation, Mesh, Acellular Dermal Matrix, and the Wise Pattern.

Background: A recent review article summarizes the discussion of mastopexy into 2 "emerging" approaches-mastopexy with autoaugmentation and mastopexy with mesh support. These concepts were introduced decades ago. This quantitative review was undertaken to explore the evidence.

Methods: An electronic literature review was conducted to identify publications that evaluated mammaplasties using a 2-dimensional measurement method that is (uniquely) capable of comparing important breast parameters, specifically breast projection and upper-pole projection.

Results: Measurement data from 20 publications were tabulated. Women treated with vertical mammaplasties showed mean increases in both breast projection (+0.69 cm) and upper-pole projection (+0.64 cm). Patients treated with nonvertical methods lost 0.77 cm of breast projection, on average. Gain in upper-pole projection was marginal (+0.13 cm). Both increments were significantly greater for vertical methods ( P < 0.0001 and P < 0.001). Implants boosted breast projection and upper-pole projection. There was essentially no benefit in breast projection or upper-pole projection in patients who received mesh.

Discussion: Despite an intuitive appeal, autoaugmentation methods do not perform. No parenchymal rearrangement can increase volume. An implant is needed to provide substantial upper-pole fullness. Vertical mammaplasties consistently outperform Wise pattern methods because of a more favorable geometry, trading width for projection rather than the reverse. Despite claims of "support," there is no evidence for improved breast shape or durability using mesh or acellular dermal matrix. An "internal bra" is a marketing concept with no reliable supportive evidence. Financial conflicts are a major consideration.

Conclusions: A recommitment to science and measurements is needed to guide treatment recommendations. Women should not be advised that autoaugmentation can mimic the effect of an implant; nor should they be offered mesh or ADM. The vertical mammaplasty should replace the Wise pattern as the preferred mammaplasty design. Vertical augmentation/mastopexy is a powerful combination.