Intramuscular and Subcutaneous Lipofilling in Mastopexy: Technical Considerations and Clinical Outcomes.

backgroundMastopexy remains the gold standard for correcting breast ptosis, yet persistent limitations include insufficient restoration of upper pole fullness and lack of long-term projection. While prosthetic augmentation addresses these concerns, implants are associated with complications and growing patient reluctance. Autologous fat transfer represents a biocompatible alternative, with regenerative potential and proven safety. However, systematic approaches to layered fat grafting during mastopexy remain underexplored.

methodsWe retrospectively reviewed 36 patients (mean age 38.5 years) who underwent mastopexy combined with intramuscular and subcutaneous lipofilling between June 2023 and June 2024. Fat was harvested via low-pressure aspiration, processed by decantation, and injected using micro-aliquot retrograde technique. Intramuscular placement targeted durable upper pole projection, while subcutaneous grafting refined contour and softness. Outcomes were assessed through standardized photography, clinical examination, complication monitoring, and patient-reported satisfaction using the BREAST-Q questionnaire.

resultsMean grafted volumes were 210 cc intramuscularly and 115 cc subcutaneously per breast. No intraoperative complications occurred. Minor delayed healing (8.3%) and small oil cysts (8.3%) were managed conservatively. No cases of infection, fat necrosis requiring surgery, or major complications were observed. At 12 months, 83% of patients reported high satisfaction (BREAST-Q ≥ 80), with the remainder reporting moderate satisfaction; no patient regretted avoiding implants. Stable upper pole fullness was achieved, though without measurable elevation of the upper breast border.

conclusionLayered lipofilling during mastopexy provides a safe and effective implant-free alternative, combining intramuscular stability with subcutaneous refinement. This approach achieves natural breast reshaping, high satisfaction, and low morbidity, though long-term durability beyond one year requires further study. 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 .