Can an Implant Smaller Than the Base Width Be Used for Augmentation Mastopexy?
Yes, an implant smaller than the breast base width can be used for augmentation mastopexy, but this approach requires specific technical modifications to prevent complications, particularly inferior pole stretch and implant malposition. The key is employing internal support techniques such as muscle slings to stabilize the implant within a larger breast envelope.
Technical Considerations for Undersized Implants
Why This Works
Muscle sling techniques specifically address the mismatch between implant size and breast envelope. The inferolateral pectoralis sling technique has demonstrated success in 284 patients (568 breasts) with only 1.8% requiring revision for implant repositioning, proving that proper internal support can compensate for size discrepancies 1.
The composite reverse inferior muscle sling (CRIMS) technique showed only 5.5% lower pole stretch over one year when used with relatively modest implant volumes (mean 255cc), with most stretch occurring in the first 6 months before stabilizing 2. This demonstrates that internal reinforcement prevents the progressive bottoming out that would otherwise occur with an undersized implant.
Critical Technical Requirements
You must create internal support structures to prevent the implant from descending within the larger breast pocket. The inferolateral pectoralis muscle sling involves undermining the pectoralis major fibers and creating a supportive hammock that holds the implant in the desired position 1, 3.
Parenchymal manipulation is essential—create medial and lateral breast "columns" by undermining the gland and excising excess tissue, then suture these columns together to reduce the effective pocket size around the smaller implant 3.
The skin envelope must be appropriately tailored through mastopexy techniques to match the final breast volume, not just the implant size alone 4, 5.
When to Consider This Approach
This technique is particularly suitable for patients with severe ptosis (grade III-IV) who desire modest volume enhancement rather than dramatic augmentation 2. In these cases, the mastopexy addresses the ptosis while the smaller implant provides upper pole fullness without requiring a large implant that might stretch the already compromised tissues.
Patients requesting conservative augmentation (180-360cc range) with simultaneous lift are ideal candidates, as demonstrated by the low complication rates in published series using these volumes 1, 2.
Avoiding Common Pitfalls
The greatest risk is premature waterfall deformity and bottoming out if you simply place a small implant in a large pocket without internal support structures 1. This is why the muscle sling or CRIMS technique is not optional—it's mandatory for success.
Augmentation mastopexy has the highest litigation rate among aesthetic breast procedures, with complications greatest when combining augmentation and mastopexy 4. Using proper internal support techniques reduces revision rates from the typical high rates to approximately 2% 1.
Avoid the temptation to oversize the implant to "fill" the base width, as this increases the risk of complications in already compromised ptotic tissue 2. Instead, use appropriate internal support with a conservatively sized implant.
Alternative Staging Approach
If you're uncomfortable with the technical complexity of single-stage augmentation mastopexy with internal support, consider using an adjustable implant (such as the Spectrum adjustable implant) that allows postoperative volume adjustment 3. This enables you to fine-tune the volume after assessing the final breast shape, avoiding many complications inherent in simultaneous procedures.
Some surgeons perform augmentation mastopexy as a two-stage procedure to minimize complications, though this requires additional surgery 3.
Expected Outcomes
With proper technique, you can expect low complication rates (2.1% late minor complications) and minimal revision needs (1.8% for implant repositioning) 1.
Lower pole stability is achieved within 6 months when using muscle sling techniques, with minimal subsequent stretch 2.
Approximately 7% of patients may request implant upsizing at an average of 13.6 months postoperatively (average increase 218.5cc), which is a reasonable secondary procedure if the patient desires more volume after seeing their initial result 1.