By Moustapha Hamdi, Dennis C. Hammond, Foad Nahai

Over the last decade vertical scar mammaplasty has won extensive attractiveness among surgeons and sufferers since it stands for minimum scars and long-lasting aesthetic effects. The refinements and adjustments of the method accomplished up to now decade and now gathered during this publication will facilitate using the procedure and provides each one plastic healthcare professional the chance to undertake his or her personal strategy to receive an optimum consequence. The step by step directions and their top of the range illustrations might help enhance effects, decrease the variety of issues and effectively deal with any problems that do come up.

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Positioning and Anesthesia Fig. 9. The patient lying on the operating table. The lower markings are well above the preexisting inframammary fold The patient is operated on in a supine position with the arms extended at 70–90° on an arm board. It is essential that the patient lie symmetrically on the operating table with shoulders and arms on each side at the same level. The patient’s placement on the operating table should be such that she can easily be brought into the sitting position. Although these procedures are possible under local anesthesia, especially for small mastopexies and reductions, I prefer general anesthesia for all breast reductions.

Alternatively, a direct measurement from the midpoint of the clavicle down to this uppermost mark can be made, with this distance measuring 21–24 cm in most patients. The inferior skin envelope is determined by direct measurement. An 8-cm pedicle width is diagrammed centered on the breast meridian. On either side of the pedicle and extending from the inframammary fold upward, a measurement of 8 to 10 cm is made. These two marks are then smoothly communicated in a line that parallels the inframammary fold (Fig.

The suture is available on a straight needle specifically designed for use as a purse-string suture. The goal of placing the suture is to use the straight needle to pass the suture directly in the substance of the dermal shelf created during flap elevation. The knot is always placed at the medial border of the periareolar opening, which allows easy identification and removal if desired at a later date. The knot must be buried below the flap; thus the suture placement is begun by passing the needle from deep to superficial and then from superficial to deep to finish.

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