Multiplanar Mastopexy in Beverly Hills | Dr. Daniel Golshani

To understand why the multiplanar approach matters, it helps to understand precisely why breast ptosis recurs after a standard lift.

Breast ptosis develops through a structural failure. The Cooper’s ligaments, the fibrous bands that suspend the breast tissue from the overlying skin and the underlying chest wall, weaken over time under the combined influence of gravity, hormonal change, pregnancy, and the weight of the breast tissue itself. As these ligaments lose their tensile integrity, the glandular tissue descends. The skin, no longer adequately supported from within, stretches. The nipple-areola complex, carried downward by the descended parenchyma, falls below its anatomically correct position.

A mastopexy that addresses only the skin envelope resolves the visible consequence of this process without addressing its anatomical source. The stretched skin is removed. The remaining skin is tightened. The nipple-areola complex is elevated to a better position. And the breast, for a period, looks lifted and reshaped.

But the internal support architecture that failed in the first place has not been repaired. The glandular tissue remains in its descended position, now enclosed within a tighter skin envelope but still without the internal structural support that would hold it there over time. As the skin relaxes through normal healing and aging, the descent recurs, typically faster than it would in a patient whose ptosis had not yet been surgically addressed.

This is the single most common reason patients present for breast revision after a previous mastopexy. Not poor skin removal. Not incorrect incision placement. The failure of the internal architecture to provide the durability that the external correction required.

The multiplanar approach is Dr. Golshani’s answer to this problem.

What Multiplanar Actually Means: The Three Planes Addressed

The term multiplanar describes a surgical approach that engages the breast across three distinct anatomical layers, each with a distinct role in the overall correction and each addressed with techniques specific to its anatomical character.

The Deep Plane: Repositioning the Glandular Tissue

The deep plane is where the glandular breast tissue, the parenchyma, sits. In a ptotic breast, this tissue has descended away from its youthful position in the upper and central breast and migrated toward the lower pole and below the inframammary crease.

In a standard mastopexy, the glandular tissue is not directly repositioned. It is enclosed within a reshaped skin envelope and the skin closure holds it in its new position. In the Multiplanar Mastopexy, Dr. Golshani directly addresses the glandular tissue itself, reshaping and repositioning it in the deep plane to restore its projection, its upper pole volume, and its anatomical position on the chest wall. This internal reshaping is performed before the skin envelope is addressed, establishing a stable, correctly positioned tissue foundation that the skin closure will then follow, rather than the skin closure bearing the entire responsibility of the lift.

The distinction matters enormously for durability. A breast that has been internally repositioned and whose glandular tissue sits in the correct anatomical position before the skin is tightened is a breast whose lift is structurally grounded. The skin closure is finishing a correction that has already been made underneath it, rather than creating the correction on its own.

The Fascial Plane: Rebuilding the Structural Support

The fascial plane is the layer of fibrous connective tissue that overlies the glandular breast tissue and serves as the structural scaffolding of the breast. This is the layer where the Cooper’s ligaments are rooted, and it is the layer whose failure contributes most directly to the development and recurrence of ptosis.

In the Multiplanar Mastopexy, Dr. Golshani addresses the fascial plane as a distinct surgical component, suturing and reinforcing the fascial tissue in a way that reestablishes the structural support architecture that ptosis has degraded. This fascial work provides the internal scaffolding that holds the repositioned glandular tissue in its correct anatomical position over the long term, transferring the structural responsibility of the lift from the skin to the internal tissue where it belongs.

This is the element of the multiplanar technique that most directly addresses the durability problem of standard mastopexy. By rebuilding the internal support rather than relying on the skin to compensate for its absence, the Multiplanar Mastopexy produces results that hold their position with a durability that single-plane techniques cannot match.

The Superficial Plane: Refining the Skin Envelope

The superficial plane is the skin envelope itself. In the Multiplanar Mastopexy, the skin component is the final layer addressed, and it is addressed from a position of strength: the glandular tissue has already been internally repositioned, and the fascial support has already been reinforced. The skin excision and closure that follows is therefore a refinement of a result that has already been anatomically established in the deeper layers, not the primary mechanism of the lift.

This changes the skin closure in a meaningful way. Because the internal tissue is already in the correct position and is internally supported, the skin envelope can be tightened and closed with less tension than a standard mastopexy requires. Closing with less tension reduces the stress on the incision sites, which in turn reduces the risk of wound healing complications, improves the quality of scar maturation, and reduces the early recurrence of ptosis that tension-bearing skin closures produce when the internal architecture is insufficient.

How the Multiplanar Mastopexy Differs From Standard Breast Lift Techniques

The clinical distinction between the Multiplanar Mastopexy and a standard mastopexy is not simply one of nomenclature. It produces genuinely different surgical outcomes in the areas that matter most to patients.

More durable results. Because the lift is grounded in internal tissue repositioning and fascial reconstruction rather than relying on the skin envelope to bear the structural load, the Multiplanar Mastopexy produces results that maintain their position significantly longer than standard techniques. The skin ages and relaxes as it always does. But the internal architecture it covers remains in the position established during surgery, providing the foundation that standard lifts lack.

Better upper pole fullness. The internal repositioning of the glandular tissue in the deep plane directly restores upper pole volume and projection in a way that skin excision alone cannot. Patients who have the Multiplanar Mastopexy frequently notice that the upper pole fullness they were concerned about, the deflated, flat zone above the nipple that is one of the most recognizable signs of a ptotic breast, is meaningfully corrected without the addition of an implant.

More natural breast shape. A breast that has been internally repositioned and supported looks and behaves differently from a breast that has only been externally tightened. It moves more naturally. Its shape reflects the underlying tissue architecture rather than the tension of a skin closure. And its projection and upper pole contour are the product of correctly positioned glandular tissue rather than a skin envelope bearing more load than it was designed to.

Lower tension at the skin closure. Closing the skin envelope over a correctly internally repositioned breast requires less tension than closing it over a breast whose internal tissue has not been addressed. This directly benefits scar quality and healing, and it reduces the early recurrence of ptosis that high-tension closures produce as the skin relaxes during healing.

Superior results in the most challenging presentations. The patients who benefit most from the multiplanar approach are those whose anatomy presents the greatest challenge to standard techniques: patients with significant ptosis, patients with significant skin laxity, patients with deflated upper poles alongside ptosis, and patients who have had prior breast surgery and present with recurrent ptosis that a surface-level re-lift cannot durably address. These are the patients whose anatomy most clearly demonstrates the limitation of working in a single plane, and for whom the multiplanar approach represents a categorically different capability.

The Multiplanar Mastopexy With Implants: Augmentation-Mastopexy at the Highest Level

The Multiplanar Mastopexy is frequently combined with breast augmentation for patients who want both a lifted position and increased breast volume.

The internal structural reinforcement of the multiplanar approach is particularly valuable in the combined augmentation-mastopexy context. One of the most significant technical challenges of simultaneous breast lift with implants is providing adequate internal support for the implant while simultaneously correcting the skin envelope, avoiding the competing anatomical demands that make the combined procedure more technically complex than either component alone.

The fascial plane reinforcement of the Multiplanar Mastopexy provides exactly the internal structural support that a simultaneously placed implant requires. The implant sits within a breast that has been internally repositioned and supported, not merely externally tightened. The risk of early implant malposition, bottoming out, and recurrent ptosis over the implant, all recognized complications of augmentation-mastopexy when the internal architecture is insufficient, is meaningfully reduced by the structural work that the multiplanar approach provides.

For patients combining the Multiplanar Mastopexy with augmentation, Dr. Golshani uses the Keller Funnel and no-touch protocol for all implant insertions, and selects implant size with particular attention to the tension relationship between the implant volume and the multiplanar-repaired envelope that will contain it.

The Multiplanar Mastopexy With Autologous Fat Grafting

For patients who want the volume restoration and natural softness of fat grafting alongside the structural correction of the multiplanar lift, the G-Stem fat grafting technique can be integrated into the same surgical plan.

Fat grafting in the multiplanar mastopexy context is most commonly used to restore upper pole volume in patients who do not want or need an implant but whose upper pole deflation is more than the internal tissue repositioning alone fully corrects, to refine the cleavage and medial breast contour, to correct residual asymmetry between the two sides, and to add the regenerative quality of concentrated adipose-derived stem cells to the breast tissue being restructured.

The combination of the multiplanar structural lift with G-Stem fat grafting produces a result that addresses all three dimensions of the ptotic breast simultaneously: the position through internal tissue repositioning and fascial reconstruction, the volume through autologous fat transfer, and the surface quality through the regenerative activity of the stem cell-concentrated graft. This is the most comprehensive non-implant breast rejuvenation approach Dr. Golshani offers, and for the right patient it is the one that produces the most complete and most natural result.

When the Multiplanar Mastopexy Is Indicated

Not every patient presenting for a breast lift requires the multiplanar approach. Dr. Golshani is direct about this during every consultation.

Patients with mild ptosis, good skin quality, adequate internal tissue volume, and modest goals may achieve an excellent result with a standard mastopexy technique. Adding multiplanar complexity to a straightforward case does not improve the outcome and is not indicated.

The Multiplanar Mastopexy is specifically indicated for:

Patients with significant ptosis where the degree of glandular descent and skin excess exceeds what a surface-level correction can durably address. Patients with significant upper pole deflation where the internal tissue repositioning of the deep plane component directly restores the fullness that skin excision alone cannot produce. Patients who have had prior mastopexy with recurrent ptosis, where the internal support failure that produced the recurrence needs to be corrected at its source rather than repeated at the surface. Patients undergoing combined augmentation-mastopexy where the internal structural reinforcement of the multiplanar approach provides the scaffolding the implant requires. And patients with complex anatomical presentations including significant asymmetry, very thin or attenuated skin, or post-weight-loss breast changes where the degree of internal tissue work required exceeds the standard single-plane technique’s capability.

When the Multiplanar Mastopexy Is Part of a Larger Plan

The Multiplanar Mastopexy is most commonly performed as the primary procedure, but it sits naturally within the broader context of comprehensive breast and body rejuvenation:

• Breast Augmentation with Implants and Fat Grafting when the volume goals extend beyond what the mastopexy and fat grafting component alone provide
• Mommy Makeover combining the Multiplanar Mastopexy with abdominoplasty and liposuction to address the full spectrum of post-pregnancy body changes in a single surgical plan
• Tummy Tuck when abdominal laxity and muscle separation accompany the breast changes, most commonly in post-pregnancy and post-weight-loss patients
• Liposuction as the donor site procedure for the fat grafting component and as a body contouring complement to the breast rejuvenation
• Nipple and Areolar Reduction and Reconstruction when the nipple-areola complex requires specific attention beyond what the mastopexy repositioning addresses
• Breast Revision for patients who have had prior breast surgery with recurrent ptosis, where the multiplanar approach corrects the internal support failure that produced the recurrence

The Standard Applied to Every Multiplanar Mastopexy

A Multiplanar Mastopexy performed to the standard Dr. Golshani holds himself to produces a breast that looks, at one year, three years, and ten years, like it has always sat in this position.

Not a breast with obvious lift scars as its most prominent feature. Not a breast that sits unnaturally high or round in the first months and then descends prematurely as the structural support proves insufficient. A breast with a natural upper pole fullness, a correctly positioned nipple-areola complex, a shape that reflects correctly positioned internal tissue rather than a tightly closed skin envelope, and a durability of position that reflects the integrity of the internal work done beneath the surface.

That is the standard. It requires more surgical depth than a single-plane approach. It requires a precise understanding of the distinct anatomical characteristics of each of the three planes being addressed. And it requires the commitment to do the internal work correctly even when the external result would be adequate without it, because adequate in the short term and durable over a decade are not the same thing.