B.A.G.S. System - Breast Lift with reduced scarring
Proprietary technique for breast lift with simultaneous volume augmentation, indicated in patients with ptosis grade 1 to 2. It combines reduced scars with internal structural support by suturing glandular pillars and anatomical polyurethane prosthesis. Trademark registered in 2008.
Breast lift and augmentation with smaller scars
The B.A.G.S. System is designed for a frequent situation: somewhat sagging breasts in which you want to recover firmness and, at the same time, gain volume, avoiding the wide scars of traditional mastopexy.
– 01 / For the patient
What is the B.A.G.S. System?
The B.A.G.S. System is a technique developed by Dr. Garcia Ceballos for a specific clinical situation: patients who have a slightly sagging breast and, at the same time, want to gain volume. That is, patients who need both a breast lift (mastopexy) and a breast augmentation (augmentation mammoplasty).
Until not so long ago, resolving these two needs in the same surgical procedure required the use of techniques with wide scars -in the shape of an “L” around the areola, or in the shape of an “inverted T” or “anchor” on the underside of the breast. These techniques are completely valid and are still necessary in many cases, but they leave scars that can be very visible, especially when an implant is also incorporated, which tightens the skin and can widen them over time.
The B.A.G.S. System proposes a different approach: taking advantage of the natural elasticity of the skin and reorganizing the internal structure of the breast to achieve the lifting effect without the need for vertical scars. The lift is obtained through a small incision at the upper edge of the areola, and the support that maintains the long-term result is achieved with internal work on the glandular pillars – the natural supports of the breast tissue – and with the appropriate implant.
B.A.G.S. stands for Breast Anchoring Band Loop Suspension, which describes the technical principle of the procedure:a system of anchoring and internal suspension of the breast tissue in the form of a loop that supports the breast from the inside, without relying exclusively on skin traction. The trademark has been registered as a notarially registered trademark since 2008.
– 02 / For the patient
Am I a candidate for the B.A.G.S. System?
Not all patients are candidates for this technique, and it is important to state this clearly. The B.A.G.S. System is designed for a specific profile, and applying it outside that profile would produce worse results than with alternative techniques. These are the criteria that are evaluated in consultation:
Some sagging of the breast, with descent of the nipple to or slightly below the inframammary fold, but without pronounced descent.
The hemiperiareolar incision is concealed by the color transition between the areola and the skin. For the scar to be hidden, the areola must be of sufficient size.
The technique does not contemplate wide resection of inferior skin. If there is a lot of sagging skin under the inframammary fold, vertical or inverted T techniques are more appropriate.
The technique is specifically designed for patients who want both in one surgical procedure. If only elevation or only augmentation is sought, other techniques may be more appropriate.
In the first consultation, the doctor evaluates these four criteria by physical examination and tells you frankly if you are a candidate for the B.A.G.S. System or if an alternative technique will give you a better result in your particular case. The fundamental criterion is to seek the best result for you, not to apply a particular technique at all costs.
– 03 / For the patient
What advantages does it have over a classic mastopexy?
When we speak of “classic mastopexy” we are referring to the vertical or inverted T-scar techniques that have been the standard for decades. These are excellent techniques and remain the best option for many patients, especially those with advanced ptosis or a lot of sagging skin. The question is not which technique is better in general, but which is better for your particular case.
| B.A.G.S. System | Classic mastopexy | |
|---|---|---|
| Scars | Upper hemiperiareolar + inframammary | Periareolar + vertical (± horizontal) |
| Visibility of the scar | Reduced and well concealed | More extensive, especially vertical |
| Volumetric augmentation margin | Wide: the implant does not tighten vertical scars | More limited due to the risk of scar tension |
| Fixation of the result | Internal, by glandular pillars | External, mainly by skin |
| Indication | Ptosis grade 1-2 with areola ≥ 3-4 cm | Advanced ptosis, excess of lower skin |
The main advantage of the B.A.G.S. System in its patient profile is that it allows for greater volume augmentation without concern for the deterioration of a vertical scar, because there simply is none. This same characteristic means that scar visibility in the long term is less.
Technical-scientific block
Technical rationale, system components, patient selection criteria and recognized limitations.
– 04 / Technical block
Basis of the technique
The classic augmentation mastopexy faces a known technical tension: the combination of breast lift and implant in the same surgical act generates opposing mechanical forces on the scar. The mastopexy pulls the tissues upwards and brings them closer, reducing the cutaneous continent; the implant, simultaneously, expands the content. This combination conditions, in the vertical or inverted T-pattern, a greater probability of widening, hypertrophy or partial dehiscence of the vertical scar, and limits the maximum volume of the implant that can be used with scar safety.
The B.A.G.S. System proposes to shift the support of the result from the skin envelope to the internal structure of the breast: instead of relying on skin resection and approximation to maintain the elevation, it resorts to a reorganization of the glandular pillars over the implant by means of controlled sutures, which act as an internal suspension system(anchoring band loop). The elevation effect on the nipple-areola complex is achieved through a limited superior hemiperiareolar incision, which takes advantage of the cutaneous elasticity without the need for a vertical pattern.
This combination, in the right patient profile, allows to obtain a mastopexy + augmentation with significantly reduced scars and with a wide volumetric margin, since the implant does not compromise a non-existent vertical scar.
– 05 / Technical block
Components of the B.A.G.S. System.
The technique integrates four components that act in a coordinated manner:
01 – Upper hemiperiareolar access
Incision limited to the upper half of the areolar border, which allows the correction and elevation of the upper pole of the nipple-areola complex, taking advantage of the natural elasticity of the mammary skin. The scar is concealed in the pigmentary transition between the areola and the surrounding skin. It is the only visible incision on the frontal plane of the breast.
02 – Inframammary access for implantation
Incision in the inframammary fold for the creation of the pocket and the implantation of the prosthesis. The scar is hidden in the natural crease below the breast and is practically invisible once consolidated. It allows direct and precise work on the implantation plane.
03 – Polyurethane anatomical prosthesis
Anatomically shaped (drop-shaped) prostheses with polyurethane covering are preferred. The anatomical shape provides a more natural volume distribution, complementing the structural effect of the abutment suture. The polyurethane coating forms a fixation layer with the surrounding tissues that minimizes rotation, displacement and the incidence of capsular contracture – a key factor for long-term stability of the result. The technique also supports round prostheses in selected cases.
04 – Suture of glandular pillars
It is the distinctive and functional element of the system. A controlled reorganization of the glandular tissue is performed by means of sutures on the medial and lateral glandular pillars above the implant, forming aband-loop that acts as ananchoring and internal suspension system(anchoring suspension). This configuration reinforces the mammary structure, contributes to the projection of the upper pole and to the durability of the result by dissociating the support of the result from the skin envelope.
– 06 / Technical block
Indication criteria
Rigorous patient selection is decisive for the outcome. The technique is indicated when the following four criteria are met:
| Criteria | Indication value | Justification |
|---|---|---|
| Degree of ptosis | Grade 1 to 2 (Regnault classification) | Allows correction with limited hemiperiareolar incision without the need for wide skin resection. |
| Areolar diameter | ≥ 3-4 cm | The incision is concealed at the pigmentary transition. Smaller areolas do not offer sufficient aesthetic margin. |
| Excess skin lower pole | Not significant | The technique does not contemplate wide resection of the lower skin; the cutaneous excess is not redistributed with this technique. |
| Aesthetic objective | Elevation + augmentation | The technique is designed to combine both in a single act. In pure elevation without augmentation or pure augmentation without elevation, other techniques are preferable. |
Relative contraindications
- Grade 3 ptosis or ptosis with excessively elongated nipple-areola complex to inframammary fold distance.
- Areolas of diameter less than 3 cm.
- Significant skin excess in lower pole requiring wide resection.
- Tuberous breast with narrow base requiring specific expansion technique.
- Patients with an expectation of volumetric augmentation disproportionate to the available envelope.
In these cases, alternative techniques – vertical pattern mastopexy, inverted T-mastopexy, or two-stage treatments – usually provide better results. The correct selection of the candidate is one of the factors with the greatest impact on satisfaction and durability of the result.
– 07 / Technical block
Recognized limitations and state of the evidence
- Restricted indication. The technique is only applicable in the patient profile described. Applying it outside this profile produces results inferior to those of conventional techniques. Patient selection is therefore an inseparable part of the system.
- Unpublished clinical evidence. The B.A.G.S. System has been registered as a trademark since 2008 and has been applied consistently in the clinical practice of Dr. García Ceballos for more than fifteen years, but has not been published in a scientific journal. External validation by independent teams and formal publication are pending work that would strengthen the available evidence.
- Dependence on the polyurethane implant. The technique is optimally designed with polyurethane prosthesis due to the stability it provides. Substitution with other types of covering (smooth, conventional textured) modifies the expected long-term behavior and should be evaluated on a case-by-case basis.
- Learning curve. Band-loop suturing of glandular abutments requires technical familiarity with functional glandular anatomy and management of the implantation pocket. Replication of the technique by other surgeons would require specific training.
Despite these limitations, the B.A.G.S. System fulfills its main objective in the patient profile for which it is intended: to provide a reduced scar augmentation mastopexy, with internal structural support, in patients with mild to moderate ptosis, adequate areola and no significant skin excess.
– 08
Associated resources
Frequently Asked Questions
The B.A.G.S. System(Breast Anchoring Band Loop Suspension) is a proprietary technique developed by Dr. José Ignacio García Ceballos to perform a breast lift with simultaneous volume augmentation in a single surgical procedure, with scars that are smaller than those of a classic mastopexy. It combines an upper hemiperiareolar access, the implantation of an anatomical polyurethane prosthesis through the inframammary route and the controlled suture of the glandular pillars to reinforce the internal structure of the breast. The trademark has been registered since 2008.
It is indicated in patients with breast ptosis grade 1 to 2 (breast slightly sagging but without pronounced descent), with a minimum areolar diameter of 3 to 4 cm and without a significant excess of skin in the lower pole of the breast. It is a particularly suitable technique when seeking to restore firmness and increase volume at the same time, avoiding the vertical scars or inverted T-shape of the classic mastopexy.
The B.A.G.S. System uses smaller incisions than the classic mastopexy (which requires a vertical or inverted T-scar), which translates into less visible scarring. It also allows a greater volume increase than would be possible with vertical or inverted T techniques, since there is no deterioration of the scar due to the effect of the volume of the implant. The glandular abutment suture provides internal structural support that contributes to the durability of the result.
Polyurethane forms a fixation layer with the surrounding tissues that significantly reduces the incidence of capsular contracture and implant displacement compared to conventional smooth or textured prostheses. This is especially relevant in a technique such as B.A.G.S., where stable implant position is essential to maintain the long-term result.
The anatomical (drop-shaped) prosthesis has a more natural volume distribution, with less projection in the upper pole and more in the lower pole, which more faithfully reproduces the natural shape of the breast. This shape is complemented by the structural effect of the glandular pillar sutures, which provide controlled projection to the upper pole. The technique also allows round prostheses in selected cases.
A minimum areolar diameter of 3 to 4 cm is required. The upper hemiperiareolar incision takes advantage of the natural transition between the pigmented areola and the surrounding skin, which conceals the scar; but this only works esthetically when the areola is of sufficient size. In patients with smaller areolas, an alternative technique is usually preferable.
The scars of the B.A.G.S. System are significantly more discreet than those of a classic mastopexy. The upper hemiperiareolar incision is hidden in the areolar transition and, once healed, is usually very inconspicuous. The inframammary incision is hidden in the natural crease under the breast. No vertical or inverted T-shaped scars are made.
The technique has not been formally published in a scientific journal, but it has been registered as a trademark since 2008. It is a technique developed and applied in the clinical practice of Dr. García Ceballos for more than fifteen years, with consistent results in his series of patients.
Other contributions by Dr. García Ceballos
The B.A.G.S. System is part of a broader set of techniques and systems developed by Dr. García Ceballos throughout his career.
The indication is evaluated in a first consultation by clinical examination and assessment of the degree of ptosis, areolar diameter and skin excess. If your profile does not correspond to this technique, you will be told frankly what alternative offers a better result in your case.