Fig. 7.8. This drawing shows the outline of the parenchymal re-section.Very little tissue is removed superiorly unless the patient has significant upper pole fullness preoperatively. The tissue resection follows a Wise pattern. It is beveled out laterally and medially but undermined inferiorly. Because the inframammary fold rises with this technique, care must be taken to remove excess subcutaneous tissue in the region between the old and the new inframammary folds - especially just lateral to the breast meridian. Postoperative puckers are less a problem of skin excess than a problem of subcutaneous tissue excess. About 1 cm of fat must be left attached to the dermis to prevent scar contracture

I rarely use drains. If a patient oozes a lot during surgery, or if a patient has had a very large resection (over 1200 g), then I will use suction drains overnight.

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