Implant-Compensable Ptosis: A Retrospective Cohort Study Comparing Polyurethane Breast Augmentation Alone Versus Augmentation-mastopexy in Patients with Mild Ptosis

Why clinicians should know about it

• Picked for Plastic and Reconstructive Surgery (paper of the day, 23 October 2026): Comparative breast augmentation and mastopexy patient outcomes

Abstract

BACKGROUND: Patients with mild breast ptosis who decline mastopexy pose a clinical challenge. Polyurethane-coated implants possess tissue-adherence properties that may compensate for mild ptosis, but no study has systematically evaluated outcomes in this specific subgroup using defined selection criteria. OBJECTIVES: To evaluate the clinical outcomes of breast augmentation with polyurethane-coated implants without mastopexy in patients with mild ptosis meeting Implant-Compensable Ptosis (ICP) classification criteria, compared to augmentation-mastopexy and augmentation in non-ptotic controls. METHODS: Retrospective three-arm cohort study of 90 consecutive patients (180 breasts) who underwent breast augmentation with polyurethane-coated implants: Group A (ICP, mild ptosis without mastopexy, n = 30), Group B (control, no ptosis, n = 30), and Group C (augmentation-mastopexy, n = 30). PRIMARY OUTCOME: BREAST-Q Satisfaction with Breasts at 24 months. SECONDARY OUTCOMES: compensation failure rate (composite of secondary mastopexy, NAC descent > 2 cm, or BREAST-Q decline ≥ 15 points), operative time, capsular contracture, complications, and patient satisfaction. Non-inferiority was assessed against a 5-point margin. RESULTS: At 24 months, mean BREAST-Q Satisfaction with Breasts was 75.6 ± 9.5 (Group A), 79.3 ± 11.2 (Group B), and 77.4 ± 9.8 (Group C). The difference between Groups A and C was - 1.8 points (95% CI: - 7.1 to + 3.5; p = 0.494), consistent with non-inferior performance, although formal non-inferiority was not established due to limited statistical power (65% vs. planned 80%). Compensation success rate was 90.3% at 24 months (3 failures: 2 secondary mastopexy, 1 anatomical). Mean operative time was 36 min shorter in Group A versus C (66 vs. 102 min; p < 0.001). No capsular contracture Baker ≥ III occurred in any group. Mean NAC descent at 24 months was 0.82 ± 0.55 cm in Group A, significantly greater than Groups B and C (p < 0.001) but below the 2.0 cm failure threshold. CONCLUSIONS: In patients with mild ptosis meeting ICP criteria, breast augmentation with polyurethane implants alone achieves BREAST-Q satisfaction scores suggestive of non-inferiority to augmentation-mastopexy at 24 months, with a 90% compensation success rate and 35% shorter operative time. Implant volume (≤ 350 cc) emerges as a potential additional criterion. The ICP classification provides the first structured framework for patient selection, counseling, and outcome monitoring in this common clinical scenario. Prospective validation is warranted. LEVEL OF EVIDENCE III: 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 .

Abstract as published, via PubMed.