Advantages of Intraoperative Marking of the New Nipple/Areola Site in Mammaplasty

1 present their method for creating the new nipple/areola recipient site in vertical mammaplasty. Any design of a new nipple/areola recipient site must be based on clear objectives. Fortunately , most of these objectives are widely accepted and are not subject to opinion. Ideally, the nipple sits at the apex of the breast, and the areola margin is circular. 2 How well does the authors' technique meet these criteria? Unfortunately, there are no before-and-after photographs to support their method. In Figure 3 presented by Lai and Lam, 1 the pattern has evidently been redrawn so that the reader cannot assess how the mosque-dome shape would appear after cinching the bottom margin (probably narrower). Moreover, the pattern is drawn on the same preoperative breast, so that one cannot judge how the shape would change after resection of a vertical ellipse. The authors inform us 1 that the result is a " somewhat asymmetric circle with a diameter of just < 5 cm. " Of course, an asymmetric circle is no longer a circle, by definition. In Figure 4 presented by Lai and Lam, 1 the breast meridian is misrepresented as a line from the nipple to the sternal notch rather than to the midclavicle, 2 which is traditionally represented by a tape measure draped around the neck. The original nipple location is drawn too far laterally , and the new nipple location is (quite severely) superomedially malpositioned. Any reliance by the reader on this diagram would be unwise. The authors 1 base the new nipple site on the superior border of the existing areola. The question is, will the nipple be appropriately positioned once the new breast mound is created? Even for experienced surgeons, it is difficult to accurately predict the exact location of the new breast apex preoperatively. 2 Patients differ considerably in their degree of pto-sis 2 and skin elasticity. The use of an implant makes this prediction even more difficult. A vertical mam-maplasty elevates the breast mound between 0 and 10 cm. 2 Commonly, the nipple position is placed too high when preoperative marking is used. 3 The Wise-pattern mammaplasty incorporates nipple transpo-sitioning that overelevates the nipple, even when limiting the vertical limb to 5 cm. 4 A recent study recommends nipple grafting to change the nipple position if necessary. 5 However, nipple/areola grafting is extremely debilitating to the nipple and should be avoided. Intraoperative nipple positioning offers …