Preoperative Markings
The preoperative markings are identical to the standard keyhole pattern described earlier (Figure 00.00). Because this technique is usually performed in the setting of very heavy breasts, remember to correct for the elasticity of the upper skin by lowering the final nipple position markings as needed. The major difference from previously described markings is that the width of the vertical portions of the keyhole may change once the resection is completed. The length of these vertical limbs should be 0 to 0 cm depending on the final size considered. Also, plan to leave a mound of lower breast tissue at the IM fold, which improves final projection.