Modern Approaches to Aesthetic Breast Surgery: A Review of Augmentation, Mastopexy, and Fat Grafting.

ABSTRACT Current trends in cosmetic breast surgery have shifted toward more balanced and natural-appearing aesthetic enhancements. Surgical planning for these procedures requires a nuanced understanding of patient goals, anatomy, implant selection, and consideration for combining procedures to achieve the desired outcome. This review aims to provide a comprehensive guide to current techniques and clinical considerations in aesthetic breast augmentation, mastopexy, and fat grafting.Patient consultation should include discussions of patient goals and expectations, a comprehensive physical exam, and preoperative patient counseling. Implant-based breast augmentation is indicated for a desired increase in breast volume. Surgeons must select the appropriate implants, plan for the most suitable plane of dissection, and discuss incision placement. Fully informed patient consent includes a discussion of breast implant-related complications including the risk of capsular contracture, implant rupture or malposition, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), breast implant-associated squamous cell carcinoma (BIA-SCC), and breast implant illness (BII). A mastopexy is indicated for correction of ptosis and improvement in breast shape. With variation in patient anatomy, different skin excision patterns, pedicle options, and use of mesh materials should be considered. Lastly, fat grafting can be a beneficial stand-alone or adjunctive procedure to improve contour and volume. Although cost has typically been a limiting factor in its adoption, fat grafting may become more popular with the shift toward more natural augmentation.Aesthetic breast surgery requires individualized surgical planning. A comprehensive understanding of augmentation, mastopexy, and autologous fat transfer will enable surgeons to tailor procedures for safe, durable, and natural-looking results.