When breasts are assessed, it is noticed that there are some similarities between the two breasts, but no two breasts are identical. The volume and consistency of breast tissue, the grade of ptosis, the position of the nipple-areola complex in relation to the breast, and the distance of the nipples from the sternal notch vary so much that it is impossible to make an acceptable classification grouping every breast. Every technique for breast reduction or mastopexy requires skin resection and tissue removal. Due to the variations, one cannot apply the same type of skin resection or tissue removal to every patient.
When planning a mammaplasty, many factors must be taken into consideration: (a) breast size and consistency, (b) grade of ptosis, (c) distance between the suprasternal notch and nipples, (d) location of the nipple on the breast, (e) skin quality, and, most important, (f) the relationship between breast tissue and skin. Depending on these factors,it is our opinion that each breast deserves individualized skin markings  (not patterns) and individualized tissue resection. In sum, the greater the skin excess in relation to the breast tissue, the more skin will be removed. The amount of skin resected determines the length of the scar. When one tries to reduce the length of the scar by limiting skin removal, the form and appearance of the breasts are usually compromised. In this chapter, first skin markings are discussed, and then the different methods of tissue removal are described.
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