{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:40:58Z","timestamp":1792428058901,"version":"4.5.0"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence IV<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-026-06318-9","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:57:02Z","timestamp":1792425422000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Does Grade I Ptosis Require Mastopexy? Implant-Only Augmentation in 198 Patients: A Clinical Framework for Patient Selection"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2992-2661","authenticated-orcid":false,"given":"Ted S.","family":"Eisenberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianne","family":"Pilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Chapa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"6318_CR1","unstructured":"International Society of Aesthetic Plastic Surgery (ISAPS). ISAPS international survey on aesthetic\/cosmetic procedures performed in 2022. 2023. Available at: https:\/\/www.isaps.org\/media\/a0qfm4h3\/isaps-global-survey_2022.pdf."},{"issue":"2","key":"6318_CR2","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/S0094-1298(20)30220-0","volume":"3","author":"P Regnault","year":"1976","unstructured":"Regnault P. Breast ptosis: definition and treatment. Clin Plast Surg. 1976;3(2):193\u2013203.","journal-title":"Clin Plast Surg"},{"issue":"4","key":"6318_CR3","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1067\/maj.2002.126746","volume":"22","author":"L Kirwan","year":"2002","unstructured":"Kirwan L. A classification and algorithm for treatment of breast ptosis. Aesthet Surg J. 2002;22(4):355\u201363. https:\/\/doi.org\/10.1067\/maj.2002.126746.","journal-title":"Aesthet Surg J"},{"key":"6318_CR4","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.bjps.2023.04.003","volume":"83","author":"MH See","year":"2023","unstructured":"See MH, Yip KC, Teh MS, Teoh LY, Lai LL, Wong LK, et al. Classification and assessment techniques of breast ptosis: a systematic review. J Plast Reconstr Aesthet Surg. 2023;83:380\u201395. https:\/\/doi.org\/10.1016\/j.bjps.2023.04.003.","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"1","key":"6318_CR5","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1177\/1090820X12469534","volume":"33","author":"JM Gryskiewicz","year":"2013","unstructured":"Gryskiewicz JM. Dual-plane breast augmentation for minimal ptosis or pseudoptosis (\u201cthe in-between\u201d patient). Aesthet Surg J. 2013;33(1):43\u201365. https:\/\/doi.org\/10.1177\/1090820X12469534.","journal-title":"Aesthet Surg J"},{"key":"6318_CR6","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-025-05326-5","author":"H Liang","year":"2025","unstructured":"Liang H, Zhang X, Liu Y, Xu B, Liu W, Li S, et al. A two-dimensional quantitative assessment method for breast ptosis following transaxillary implant augmentation. Aesthetic Plast Surg. 2025. https:\/\/doi.org\/10.1007\/s00266-025-05326-5.","journal-title":"Aesthetic Plast Surg"},{"issue":"5","key":"6318_CR7","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1097\/00006534-200104150-00027","volume":"107","author":"JB Tebbetts","year":"2001","unstructured":"Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft tissue relationships in a wide range of breast types. Plast Reconstr Surg. 2001;107(5):1255\u201372.","journal-title":"Plast Reconstr Surg"},{"issue":"7 Suppl","key":"6318_CR8","doi-asserted-by":"publisher","first-page":"136S","DOI":"10.1097\/01.prs.0000247311.12506.d7","volume":"118","author":"SL Spear","year":"2006","unstructured":"Spear SL, Boehmler JH IV, Clemens MW. Augmentation\/mastopexy: a 3-year review of a single surgeon\u2019s practice. Plast Reconstr Surg. 2006;118(7 Suppl):136S-147S.","journal-title":"Plast Reconstr Surg"},{"issue":"2","key":"6318_CR9","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1097\/PRS.0000000000000387","volume":"134","author":"MR Lee","year":"2014","unstructured":"Lee MR, Unger JG, Adams WP Jr. The tissue-based triad: a process approach to augmentation mastopexy. Plast Reconstr Surg. 2014;134(2):215\u201325. https:\/\/doi.org\/10.1097\/PRS.0000000000000387.","journal-title":"Plast Reconstr Surg"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-06318-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-026-06318-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-06318-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:57:04Z","timestamp":1792425424000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-026-06318-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":9,"alternative-id":["6318"],"URL":"https:\/\/doi.org\/10.1007\/s00266-026-06318-9","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"value":"0364-216X","type":"print"},{"value":"1432-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"assertion":[{"value":"12 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no conflicts of interest to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","label":"Human and Animal Rights","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all individual participants involved in the study.","order":3,"name":"Ethics","label":"Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}