I'm going to show you markings today for a mastopexy with an auto-augmentation and this has been well described by multiple authors as we mentioned in the paper itself. This technique really works with many types of mastopexy so basically you can mark your mastopexy however you are comfortable marking as long as it has a superior or a supramedial pedicle. So I like to mark the midline as well as the breast meridian, the folds and then I mark a horizontal line at the axillary fold or you could mark upper breast border. That is for me in order to have an intraoperative mark to measure for symmetry later. So again you really can mark however you're comfortable marking as long as it is a superior or a supramedial pedicle. For me I generally will decide this based on whether or not I'm removing tissue and how far I need to move the nipple areolar complex. If I'm going to be removing some tissue then I will typically almost always use a supramedial pedicle or if I have to move the nipple areolar complex more than just a few centimeters. In this particular patient I am not going to commit 100% to the areolar position and instead I'm going to mark my vertical limbs and I can commit to that areolar opening intraoperatively. I also like to say that it's not what you take it's what you leave behind and so I like to measure the skin envelope that I'm going to be leaving behind more so than the skin that I'm going to be resecting. Now, for the inferior aspect, you could do a wise pattern skin resection or a vertical pattern skin resection. In this patient, I'm marking a vertical skin pattern resection. However, intraoperatively, I will often shorten the vertical distance and create an inframammary fold incision in order to shorten that distance based on how things look at the end. And again, in her, I am going to be reducing some tissue. So this will be a supramedial pedicle. And then this inferior tissue here is going to be used for the auto augmentation, which you can see in the intraoperative photographs in the article. The inferior skin gets undermined in a thin fashion, similar to other vertical mastopexy techniques as the fold will raise. And then that tissue that I've marked is what will be mobilized on a central blood supply pedicle. You don't really have to mobilize it once you have elevated medial and lateral pillars and you have elevated your inferior skin. Then that tissue is quite mobile and can be easily mobilized up into the supramedial pocket.

mastopexy

auto-augmentation

superior pedicle

marking techniques

surgical symmetry