Total Pedicle Preservation Mastopexy: Technique, Safety, and Long-term Results

Abstract Background Mastopexy aims to correct breast ptosis and restore contour and position, but existing techniques may compromise nipple–areola complex (NAC) vascularity, sensitivity, or lactation potential. Reported limitations include recurrent ptosis, bottoming out, and perfusion-related complications. Objectives The aim of this study was to evaluate the long-term safety, stability, and effectiveness of total pedicle preservation mastopexy (TPPM) in women undergoing mastopexy. Methods A prospective case series of 488 women (cup size A-D, grade I-II ptosis) underwent TPPM between 2012 and 2022, performed by a single surgeon. Patients were followed at 1, 6, 12, and 24 months. Primary outcomes included sternal notch-to-nipple (SN-N) distance, nipple-to-inframammary fold (N-IMF) distance, breast density (Shore O Durometer), and areolar diameter. Complications were recorded. Results Mean SN-N distance decreased from 25.22 cm preoperatively to 20.65 cm at 24 months (P < .001). N-IMF distance increased modestly from 7.2 cm postoperatively to 8.1 cm at 24 months, corresponding to a 52.9% relapse of the initial correction with 47.1% of the initial correction maintained. Breast density increased from 7.6 to 8.8 Shore O units at 24 months (P < .001), remaining above baseline. Areolar diameter decreased from 64.2 mm preoperatively to 42.0 mm at 24 months. The overall complication rate was 2.5%. 12 events in 488 patients with no cases of NAC necrosis, hematoma, wound dehiscence, or infection. Conclusions TPPM is a safe, reproducible mastopexy technique that achieves stable long-term results. It offers an effective alternative for patients seeking durable, natural outcomes without implants or major tissue excision. Level of Evidence: 4 (Therapeutic) For image description, please refer to the figure legend and surrounding text.