Modified peri-areolar mastopexy and fat grafting in complex breast ptosis: A randomized open-label controlled trial

background: complex breast ptosis may be caused by moderate to severe degrees of skin and glandular sagging associated with breast and nipple-areola complex (NAC) asymmetries and deformities. the use of traditional peri-areolar mastopexy (t-PM) with or without implants is limited only to mild or moderate breast ptosis. objectives: this study aimed to report the safety and efficacy of the modified peri-areolar mastopexy (m-PM) characterized by a vertical shift of the classical pattern with implants and fat grafting (FG) in complex breast ptosis and to evaluate the influence of breast and NAC asymmetries, breast, and chest deformities on aesthetics outcomes. methods: an open-label randomized controlled trial was performed. Forty women (study group - SG) affected by breast ptosis (moderate and severe), asymmetries, and deformities were treated with m-PM, implants, and FG, and their outcomes were compared with those in a control group (CG) (n = 35) treated with t-PM and implants. aesthetic outcomes were evaluated using the patient's satisfaction grade, physician's assessment score, and visual analog Scale (VAS). results: overall, 75% (n = 30) of SG patients reported excellent results in terms of breast lift, shape, volume, NAC position, and scar quality after 12 months, whereas the CG reported the same outcomes in 60% (n = 21) of the cases. SG patients showed a vertical NAC shift and a satisfaction degree higher than that in the CG (p < 0.001 vs. CG). conclusions: the m-PM with implants and FG was found to be safe and effective in this trial.