Traditional mastopexy deals with the two-dimensional skin excess seen in mastopexy patients. Depending on the skin envelope, a peri-areolar, vertical, or Wise pattern external mastopexy may be performed; but to effect a three-dimensional change in the breast, a third dimension of tightening must be performed. This paper reviews the Superficial Fascia System of soft tissues and how it pertains to breast surgery and introduces a novel approach to internal mastopexy, using a purse string technique to cinch the base diameter of the breast by tightening the circum-mammary ligament, which is the fascial boundary of the breast where it fuses to the deep fascia and chest wall. Photos, diagrams and OR videos are used to illustrate the anatomic principles and technique. Before and after photos of various breast procedures provide examples of the broad utility of this technique.

Download