How the evidence was selected: Criteria for the latest five reviews

A targeted PubMed search identified five high-level publications from 2024 to 2025 that met strict inclusion criteria. Only systematic reviews and meta-analyses reporting outcomes relevant to mastopexy risks and complications were included. These publications examine complication patterns in cosmetic mastopexy, mastopexy combined with implants or fat grafting, pedicle-dependent outcomes, and mastopexy performed in staged surgical pathways. Narrative reviews, retrospective single-centre studies and non–PubMed-indexed sources were excluded to maintain methodological consistency.

Complications most frequently reported in recent reviews

Across the selected systematic reviews and meta-analyses, mastopexy demonstrates a generally favourable safety profile. Most reported complications are mild to moderate, manageable and correctable with appropriate surgical planning and follow-up.

Commonly reported complications include:

– Delayed wound healing or minor wound dehiscence

– Infection or superficial surgical-site inflammation

– Seroma or localized fluid collection

– Hypertrophic or widened scarring

– Transient changes in nipple–areola complex sensation.

More clinically significant but less frequent complications include:

– Partial nipple–areola complex ischemia or necrosis

– Hematoma requiring evacuation

– Persistent asymmetry or contour irregularities

– Recurrent ptosis or loss of upper pole support over time.

The reviews consistently report low rates of severe complications, particularly when mastopexy is performed with appropriate patient selection and preservation of vascular supply.

Patient-related and anatomical risk factors

Recent reviews highlight that local anatomical and tissue-related factors play a greater role in mastopexy risk than systemic comorbidities alone. Key patient and anatomical risk factors include:

– Poor skin elasticity and significant dermal laxity

– Large breast volume with heavy lower pole tissue

– Long nipple-to-inframammary fold distance

– Compromised vascularity due to prior breast surgery

– Smoking and impaired microcirculation

– Thin soft tissue envelope, increasing wound stress.

The systematic reviews emphasise that understanding vascular anatomy of the nipple–areola complex and tissue load distribution is essential to reducing ischemic and wound-related complications.

Complications related to the chosen technique

Complication rates in mastopexy are strongly influenced by surgical technique, pedicle selection and whether adjunctive procedures are performed.

Pedicle selection and technique-dependent outcomes

The 2025 meta-analysis comparing superomedial and inferior pedicles demonstrated that technique choice influences the complication profile:

– Superomedial pedicles were associated with lower infection rates

– Higher incidence of seroma formation was reported with certain pedicle designs

– Differences in nipple–areola complex sensory changes were observed between techniques.

These findings confirm that complication risk is not uniform and varies according to pedicle design and tissue handling.

Mastopexy combined with implants or fat grafting

The 2025 systematic review on periareolar mastopexy with implants and fat grafting reported complication patterns including:

– Delayed wound healing at the periareolar incision

– Capsular contracture in implant-based cases

– Fat resorption or irregular contour following grafting

– Infection and hematoma at low but clinically relevant rates.

These outcomes highlight the importance of careful patient selection and realistic counselling when mastopexy is combined with volumetric enhancement.

Mastopexy in staged surgical pathways

Systematic reviews evaluating staged mastopexy prior to nipple-sparing mastectomy demonstrated:

– Low rates of nipple–areola complex necrosis

– Acceptable flap viability when adequate healing intervals are respected

– Comparable complication rates to non-staged approaches in selected patients

These findings reinforce that mastopexy can be safely incorporated into staged surgical plans when vascular preservation is prioritised.

Severe complications and rare events

Across the selected reviews, severe or life-altering complications are uncommon. The most serious events relate to:

– Partial or total nipple–areola complex necrosis

– Major wound breakdown requiring revision surgery.

Such events are typically associated with compromised vascular anatomy of the breast and nipple–areola complex, excessive tissue tension created during reshaping, and patient-related factors such as smoking or impaired wound-healing capacity. Inadequate staging or overly aggressive reshaping in high-risk anatomy further increases susceptibility to these complications. 

Key predictors of surgical outcomes and complications

Across all five reviews, several consistent predictors emerged:

– Mastopexy outcomes are highly technique-dependent.

– Preservation of vascular supply is critical for NAC safety.

– Combined procedures increase complexity but remain safe in experienced hands.

– Patient factors such as skin quality and smoking status significantly influence risk.

– Staged approaches reduce ischemic complications in high-risk anatomy.

Complication risk is best understood as a multifactorial interaction between anatomy, technique and patient-specific factors.

Overall breast lift risk profile: What this means for practice

– Mastopexy is considered a safe and effective procedure with a low rate of major complications.

– Most complications are mild, manageable and correctable.

– Technique selection and vascular preservation are central to risk reduction.

– Combined and staged procedures require careful planning but do not inherently increase severe complication rates.

– Transparent patient counselling regarding scarring, sensation changes and long-term ptosis risk supports high satisfaction.

When performed by experienced surgeons with appropriate patient selection, mastopexy demonstrates predictable outcomes and a favourable safety profile.

Bibliography: The five latest PubMed-indexed articles considered

– Tanas Y. Comparative Outcomes of Superomedial and Inferior Pedicles in Breast Reduction and Mastopexy: A Meta-Analysis of 5123 Breasts. Aesthetic Plastic Surgery. 2025. PMID: 39433614

– Gibson E. Staged Breast Reduction or Mastopexy before Nipple-Sparing Mastectomy: A Systematic Review and Meta-Analysis. Plastic and Reconstructive Surgery. 2025. PMID: 40138174

– Milani-Reis A. The Use of Poly-4-Hydroxybutyrate (P4HB) Scaffold in Cosmetic Breast Surgery: A Systematic Review and Meta-Analysis. Aesthetic Plastic Surgery. 2025. PMID: 41145855

– Hinson C. Staged Mastopexy or Mammaplasty Prior to Nipple-Sparing Mastectomy: A Systematic Review of Safety and Nipple-Areola Complex Outcomes. Aesthetic Surgery Journal. 2025. PMID: 40203283

– Gentile P. Systematic Review: Periareolar Mastopexy with Breast Implants and Fat Grafting. Aesthetic Plastic Surgery. 2025. PMID: 40764885