Augmentation of the ptotic breast: Simultaneous periareolar mastopexy/breast augmentation**

Background: Submusculofascial augmentation of the ptotic breast can result in a “double-bubble” appearance, because a submusculofascial implant will lay superior to the ptotic gland. Subglandular augmentation in a ptotic breast avoids a “double-bubble” but will aggravate the preexisting ptosis. Objective: The purpose was to review the technique of augmentation of the ptotic breast with a submusculofascial implant and simultaneous periareolar mastopexy. Methods: Twenty-three patients were treated with the technique of simultaneous periareolar mastopexy/breast augmentation over a period of 18 months. Results: This technique avoids the “double-bubble” appearance and leaves a minimal periareolar scar. There was one complication, a case of partial areolar necrosis. The most common errors in surgical technique were inadequate elevation of the nipple-areolar complex, inadequate periareolar skin excision, and the use of too small an implant. Conclusions: Simultaneous periareolar mastopexy/breast augmentation is useful for augmenting the ptotic breast when augmentation alone will fail to give a satisfactory aesthetic result.