Vertical Mammaplasty Marking Using the Key Hole Pattern Nazim Gumus, Yusuf Kenan Coban, and Mehmet Serdar Demy´rkiran 1 Department of Plastic Surgery, Adana Numune Research Hospital, Adana, Turkey 2 Department of Plastic Surgery, Medical Faculty of Su¨tc¸u¨ _ Imam University, Kahramanmaras, Turkey Abstract. Many modifications of the vertical mammaplasty procedure used to shorten the learning curve have been described. The authors advocate marking the breasts for the vertical mammaplasty operation according to the key hole pattern. They have used inverted T techniques on the upper breast and Lejour’s vertical mammaplasty on the lower breast. A total of 14 patients who had breast hypertrophy and ptosis underwent operations with this marking modification. The amount of removed breast ranged from 285 to 875 g per breast. Hematoma, skin necrosis, skin dehiscence, loss of nippleÀareola sensitivity, and distortion were not observed in these cases. Key words: Key hole pattern—Mastopexy—Reduc- tion—Vertical mammaplasty Vertical mammaplasty is one of the best methods for reduction mammaplasty and mastopexy. In contrast to other inverted T techniques, this procedure offers less scar formation, better projection and appearance of the breasts, and lack of submammarian scar for- mation. As a result, vertical mammaplasty has gained popularity over the past decade, and currently is preferred by many plastic surgeons. This procedure with its many advantages over other techniques has been accepted worldwide. Because of the difficulties in marking and resection with this procedure, many surgeons still are not eager to perform the technique. Several vertical mammaplasty modifications have been published recently to give the learning curve extra momentum [1,5,6,10]. However, there still are difficulties in marking and resection with the vertical mammaplasty operation. The learning curve is be- lieved to be long, and cosmetic outcomes may be inconsistent, although modifications to simplify the procedure have been proposed [4]. The literature shows that it is possible sometimes to combine two different methods to obtain better re- sults than achieved by each method separately [12]. Several methods that modify the vertical mammapl- asty technique make it easier to perform. One of these, described by Hall-Findlay [6], which includes a medial or lateral dermoglandular pedicle without skin undermining and pectoralis fascia sutures. The evolution in techniques for vertical mam- maplasty has reduced complication rates [3]. Reduc- tion in skin undermining and avoidance of liposuction have dramatically decreased minor com- plication rates. The most difficult aspect in vertical mammaplasty is the lack of a simple pattern to follow such as those for the McKissock or Strombeck techniques [11]. This may be the case because the technique can be used for small reductions or reduction weights of more than 2 kg per breast. A more reliable marking method for vertical mammaplasty is needed. In this article, we describe a new adaptation and a combination of two different marking methods for the technique. Methods Markings The patient stands preoperatively in the upright po- sition. Meridian and midline stripes of breast are marked from the middle point of the clavicle to the nippleÀareola, and from the sternum to the umbli- cus. These markings then are extended to the upper abdomen (Figs 1d, e, f; 2d, e; and 3a, b, 4a, b). The planned nipple location is determined to be at or just below the inframammary fold on the midaxial line. The distance between the suprasternal notch and the Correspondence to Yusuf Kenan Coban, Sutcuimam Uni- versity School of Medicine; email: kenancoban@ksu.edu.tr Aesth. Plast. Surg. 30:239À246, 2006 DOI: 10.1007/s00266-005-0106-0 Innovative Techniques