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The Sitting, Oblique, and Supine Marking Technique for Reduction Mammaplasty and Mastopexy

Background: Reduction mammaplasty is one of the most common procedures in plastic surgery. It presents both artistic and technical challenges. Breast reduction surgery aims to reduce the vertical and horizontal planes, shape the parenchyma, reposition the nipple-areola complex, and resect redundant skin. The surgery on paired organs has the added challenge of symmetry. Much of the outcome of our work as plastic surgeons is determined by preoperative planning and designing. Methods: A number of techniques have been described for the preoperative marking of breast reduction, with particular reference to the precision of the angle between the two vertical limbs. Few, if any, of the previous techniques have gained total popularity or acceptance by plastic surgeons. Results: The freehand marking technique is probably the most widely used technique. Devices such as templates, shaped wires, and goniometers, and geometric techniques, have also been recommended. Some of these devices have stood the test of time; others have been modified or abandoned. Conclusions: The authors propose a new preoperative marking technique dependent on the natural breast fall. The patient is marked in three positions: sitting, oblique, and supine. This technique has been adopted for the past 10 years.