Mastopexy With Inferior-Septal Pedicle and Dermal Fixation: A Modification to Improve Aesthetic Stability

BACKGROUND: Breast ptosis remains challenging, particularly when excess skin and parenchyma are pronounced. Inferior-pedicle techniques may be prone to recurrent ptosis with lower-pole elongation and loss of upper-pole projection. OBJECTIVES: The aim of the study was to describe and evaluate a mastopexy technique using an inferior-septal pedicle with dermal-muscular fixation designed to enhance long-term stability in severe ptosis (Regnault grade III). METHODS: Single-surgeon, single-center consecutive case series (Level IV). One hundred and sixteen women with Grade III ptosis underwent surgery from January 2016 to June 2023. The technique uses an inferior-septal dermoglandular pedicle with dermal fixation to the pectoralis major. Outcomes were assessed through standardized examinations, photography, and the BREAST-Q Reduction/Mastopexy module at 3, 6, and 12 months. RESULTS: A total of 116 patients were analyzed (median follow-up, 12 months). Mean suprasternal notch-nipple distance decreased from 36.3 to 22.0 cm, and nipple-inframammary fold from 14.5 to 8.0 cm at 12 months. BREAST-Q scores at 12 months demonstrated high satisfaction (mean ≥80/100). No NAC-related vascular events, infections, or hematomas occurred (0%). Wound-healing disturbances were noted in 16/232 breasts (6.9%). Revisions occurred in 13/116 patients (11.2%), mainly scar adjustments; secondary ptosis correction was required in 5/116 (4.3%). No cases of persistent nipple sensory loss were observed. CONCLUSIONS: The proposed mastopexy technique with inferior-septal pedicle provides effective correction of severe ptosis with good upper-pole fullness and stable long-term breast shape, while preserving NAC perfusion, innervation, and potential lactational function. LEVEL OF EVIDENCE: 4 (THERAPEUTIC): For image description, please refer to the figure legend and surrounding text.