The sitting, oblique, supine (SOS) marking technique for mastopexy and breast reduction

Abstract

Macromastia can cause considerable emotional and physical stress. The problem of macromastia has been the subject of the efforts of many plastic surgeons since late nineteenth century. In United States alone nearly 40,000 women undergo breast reduction each year [1]. Breast reduction presents both artistic and technical challenges. The surgery aims to reduce the vertical and horizontal planes, shape the parenchyma, reposition the nipple-areola complex, and resect redundant skin. The surgery on paired organs has the added challenge of symmetry. The added effect of recumbence alters the shape and position of the breast. The classic breast shape, as we know it, exists in the erect posture. Much of the outcome of our work as plastic surgeons is determined by preoperative planning and designing. The availability of numerous marking techniques of breast reduction and mastopexy and the abundance of further modifications over the last decennia are clear indications that none of these techniques have proved to be ideal. The majority aim to achieve some degree of precision in determining the angle between the two vertical limbs. This ultimately affects the amount of tissue resected and the postoperative shape. Few, if any, of such techniques have gained total popularity or acceptance by the plastic surgeons. The freehand marking technique is probably the most widely used technique. Devices as templates [2, 3] shaped wires, goniometers, and geometrical techniques have also been recommended [4-9]. Some of these devices have stood the test of time; others have been modified or abandoned. The free hand technique, being the most widely used, requires experience and practice in order to achieve the desired results. Multiple devices have been created to facilitate markings, including templates, keyhole patterns, goniometers, etc. The standard pattern with a fixed angle of 110 between the two segments was further modified by McKissock [10] to allow for adjustment of the angle to the widely variable breast shapes. The wire keyhole pattern marking is influenced by the surgeon s experience [11]. The standard patterns and devices are rigid methods that may achieve symmetrical markings, not necessarily symmetrical outcomes. They do not account easily to preexisting breast asymmetry. Devices may also be not readily available in all hospitals. This factor could be a disadvantage to the surgeon who practices in more than one hospital. The inherent difficulties of these techniques, the lack of flexibility, and the need to memorize different measures and mathematical calculations on some occasions made me alter my approach in the preoperative marking. Over the last 15 years, I have developed the sitting, oblique, supine (SOS) marking technique. This method is dependent on the natural breast fall and is aimed to guide the required angle between the two vertical limbs, each breast on its individual merits. It would be applicable in most breast reduction and mastopexy surgery; however, it is used largely in the inferior pedicle technique. © 2009 Springer-Verlag Berlin Heidelberg.