When Does Grade I Ptosis Require Mastopexy? Implant-Only Augmentation in 198 Patients: A Clinical Framework for Patient Selection

Background Management of Grade I breast ptosis remains controversial because many women desire breast augmentation while wishing to avoid the additional scars associated with mastopexy. Although anatomical measurements are important, less guidance exists regarding how surgeons integrate these findings with tissue characteristics and patient expectations when determining whether augmentation alone is appropriate. Objectives The aim was to evaluate the clinical outcomes of implant-only dual-plane II breast augmentation in carefully selected women with Grade I ptosis and to describe a clinical framework for patient selection. Methods A retrospective review was performed of 3,265 consecutive primary breast augmentations performed by a single surgeon between 2009 and 2022. After applying predefined inclusion and exclusion criteria, 198 consecutive women (6.1%) with Grade I ptosis underwent augmentation alone. Patient selection incorporated anatomical measurements, clinically estimated native glandular volume, tissue characteristics, and shared decision-making. Clinical outcomes and secondary procedures were evaluated. Results The study cohort included 194 saline and 4 silicone gel breast augmentations. Two patients (1.0%) underwent revision for superior implant malposition. No postoperative hematomas, infections, or capsular contractures occurred. Only one patient (0.5%) elected delayed mastopexy during subsequent clinical follow-up. At initial consultation, 48 patients (24.2%) believed augmentation mastopexy would be required; following comprehensive assessment, patient education, expectation alignment, and shared decision-making, these patients elected augmentation alone. Conclusions For carefully selected women with Grade I ptosis, augmentation alone represents a reasonable alternative to routine augmentation mastopexy. Appropriate patient selection extends beyond anatomical measurements alone and is enhanced by integrating tissue characteristics, clinically estimated glandular volume, expectation alignment, and shared decision-making into the preoperative consultation. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .