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The study sought to plan mastopexy and breast reduction according to the principle of the divine proportion, represented by the letter phi, via the convergent assembly of multiple layers to create the new breast. The mean patient age was 36 years. The follow-up ranged from 6 months to 3 years. This approach adds precision to mammaplasty, reduces the laxity in the axillary region, promotes bulk in the upper pole, and eases nipple—areola complex elevation. The current techniques employed for breast reduction, mastopexy with or without implants, are planned using the pinch test, prefabricated molds, and several other empiric strategies.

Breast divine

Breast divine

Breast divine

Breast divine

Breast divine

He is "Papa," who adores his grandkids and he is a loving husband and father. The L short-scar mammaplasty. We have to consider that the anatomical NAC positioning is divergent Breast divine of curved rib arches Fig. Pitanguy 22 imagined the superior border of the areola by feeling the projection of finger over the upper pole after touching the meridian of the breast integument inferiorly at the submammary Brrast. Integument mobilization utilizes different Breast divine or pedicles to ease NAC elevation and to fill the upper pole. Our vision is to develop future oncology leaders through innovative cancer research, education, and interdisciplinary compassionate care. In this case, P1 to m measured 7. Our investigation defines comprehensive process Douching menstruation by the universal principle of Breast divine divine proportion. The mean patient divinr was 36 years. The study sought to plan mastopexy and breast reduction according to the principle of the divine proportion, represented by the letter phi, via the convergent assembly of multiple layers Breast divine create the new breast.

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The study sought to plan mastopexy and breast reduction according to the principle of the divine proportion, represented by the letter phi, via the convergent assembly of multiple layers to create the new breast. The mean patient age was 36 years. The follow-up ranged from 6 months to 3 years. This approach adds precision to mammaplasty, reduces the laxity in the axillary region, promotes bulk in the upper pole, and eases nipple—areola complex elevation. The current techniques employed for breast reduction, mastopexy with or without implants, are planned using the pinch test, prefabricated molds, and several other empiric strategies.

The breast assembly usually is achieved by approximating the border of the remaining tissue to form the base of the new breast cone. Integument mobilization utilizes different flaps or pedicles to ease NAC elevation and to fill the upper pole. All these strategies reflect the challenge to obtaining a desirable breast outcome.

Attractive breast geometry depends on the achievement of the golden ratio among the submammary fold, NAC border, and sternal midline. Therefore, the purpose of this study was to plan mastopexy and breast reduction according to the principle of the divine proportion, 15 — 17 denoted by phi, with centripetal multiplanar ie, multiple layer assembly of the new breast. This strategy is based on the constancy of the submammary fold, with the breast planned over a V-shaped isosceles triangle with a vertex at the umbilicus.

Each branch of this triangle opens in the direction of the acromioclavicular joint and functions as a vanishing point that orients the vertical and horizontal resection and the convergent assembly of the mammary tissue.

The mean age of the patients was 36 years. The new breast is planned over a V-shaped triangle with the vertex situated at the umbilicus, point u. P1, the key point of the strategy, is situated at the intersection of each branch of the V-shaped triangle with the submammary fold. Planning the new breast in the orthostatic and supine position.

A, The golden ration can be seen in an attractive breast. B, Planning the new breast. With the patient in a standing position, the submammary fold is delineated. The branches of the isosceles of the triangle run in the direction of the acromioclavicular joint. Its intersection with the submammary fold gives the origin of P1, the key point. D, P2 is situated over the branch of the triangle with the vertex at point u umbilicus running to the acromioclavicular joint.

The amount of the horizontal resection is calculated by pulling the breast with a hook at P2. In this case, P1 to m measured 7. Then, the horizontal excess of the hypertrophic integument preserved The breast is assembled with multiple internal layers, and the auxiliary pulls the lateral quadrant in the direction of P1. Depending on the extent of tissue resection, usually, 4—8 retention sutures are used between the inner layers of the breast integument and the pectoral muscle Fig.

Usually, 6—8 adhesion sutures are used to mobilize the lateral quadrant in the direction of P1 and 2—3 stitches are used from the mammary sternal medial border, also in the direction of P1 Fig. In the same fashion, the dermal layer is sutured. The V-shaped branch of the triangle orients the objective amount of vertical resection along the axis P1 toward P2.

The epithelium is removed to complete Schwarzmann maneuver and is facilitated using tumescent infiltration between the epidermal and dermal layer with saline solution without epinephrine. If necessary, the dermis around the NAC can be incised to help its transposition at P2.

Lipoplasty under the areola and the upper pole eases NAC repositioning overall in large fat breast, prevalent in overweight patients mainly after fifth decade. It preserves subdermal vascular plexus around areola important to maintain adequate lyphatic and venous drainage.

The breast assembly is oriented by the axis of the umbilicus and the acromioclavicular joint. The integument is sutured in a multiplanar, that is, multilayer fashion with absorbable retention sutures over the serratus and pectoralis major muscle. The breast lateral quadrant converges in a centripetal rotation to point P1.

The medial quadrant is also rotated to P1. This is a very strong layer. Finally, the suturing is completed with running sutures of the subdermal and intradermal layers.

Centripetal rotation of breast tissue from the sternum region to P1 completes the assembly. The vertical amount of skin is objectively evaluated and completed with Schwarzmann maneuver. The NAC is positioned at the apex of the breast along the branch of the triangle that starts at the umbilicus.

See video, Supplemental Digital Content 1, which demonstrates the divine proportion concept in planning the vertical and horizontal resection, the steps of multiplanar convergent assembling, the ideal NAC positioning in a year-old patient presenting intermediated body type and large breast reduction.

To obtain an objective analysis of the esthetic result, the data are evaluated according to Strasser grading. The absence of any of these flaws is considered a perfect result; thus, with this system, a perfect result obtains zero points.

The inclusion criteria consisted of breast reduction or mastopexy with upper pedicle. Breast reduction using an inferior pedicle or associated with an implant was excluded from study. A desirable breast outcome was achieved in most of the cases of breast reduction and mastopexy. Centripetal mobilization of breast tissue to point P1 reduced axillary laxity contributing to upper pole projection.

Good scarring was noticed overall at the submammary fold. In a few cases, complications such as asymmetry, partial nipple necrosis, and delayed healing scored at the lower limit of Strasser grading system, that is, scores 5—14, which is considered mediocre. All of these complications occurred in patients presenting with large breasts. Current mammaplasty approaches use pinch test, prefabricated molds, and even complex empirical markings to plan the new breast.

This study evokes the mathematical principle of the divine proportion to construct a balanced breast Fig. With this method, point P2 is vertically positioned at the distance of P1 to the point m—the intersection with the midsternal line—times the constant phi, 1. This mathematical proportion shows that P2 is also situated at the longitudinal line coincident with a point between the distal third and medial two thirds of the distance between the anterior axillary anterior line and the presternal midline.

The new mammary cone is planned taking into consideration the submammary fold, a constant structure that is the foundation to built the new breast and must be determined with the patient in an upright standing position. The method also employs another objective parameter: the triangle with the vertex, point u, situated at the umbilicus. Each branch opens in the direction of the acromioclavicular articulation parallel to the anatomical mammary line.

P1, the key point, is situated at the intersection of the submammary fold line and each branch of the V-shaped triangle. Each axis of the branch of this isosceles triangle orients the creation of the new breast. The geometric explanation shows that the divine proportion can be detected from a mathematical point of view in the ideal breast as we seen in a breast augmentation. All of this theory can be simplified by considering geometric parameters according to body types. As point out by Del Yerro, 21 the breast must maintain a harmonious proportion within the body that frames it.

Usually, in a thin body corresponding to the asthenic or ectomorphic body type, the normal distance from P1 to m is 6. The shape of the base of the breast cone is more oval with a larger vertical axis. In these cases, the breast horizontal axis is larger than the vertical one Fig. Between these 2 types is the intermediate type, the most prevalent in our investigation, in which the P1 to m average distance is 7—7.

We have to consider that the anatomical NAC positioning is divergent because of curved rib arches Fig. TP indicates thoracic perimeter. This case scored 3 according to Strasser classification. See NAC rotation proportioned by multiplanar-layered assembly compare the black nevus position on the right breast at the upper pole before and after surgery.

See the improvement at the axillary region, the rotation of the NAC, and the maintenance of upper pole projection as a result of multiplanar convergent centripetal assembly of the breast lateral and medial quadrants. Schematic drawing showing the divergence of the breast cone and the NAC because of the convexity of the costal arches of the ribs.

The vertical meridian of the NAC has to be positioned under a descendent line that runs from the lateral one third with the medial two third of the distance between the axillary crease and the presternal midline. Patients between these 2 values have an intermediate body type, that is, the Y value is close to 4 between 3. In this way, we add precision to cone apex positioning. In contrast to many current techniques that use only the pinch test to plan the NAC topography.

Wise 7 utilized prefabricated molds with their apex at a constant distance from the SN to the areola border. Pitanguy 22 imagined the superior border of the areola by feeling the projection of finger over the upper pole after touching the meridian of the breast integument inferiorly at the submammary fold.

Tebbetts 23 considers the half size of the submammary fold to project NAC and to evaluate the vertical and horizontal excess to be resected. These strategies show the challenging difficulties of adding mathematical precision according to different body types.

By determining P2, planned topography of superior border of NAC positioning, horizontal resection can be measured objectively. With an upward traction at this point and breast tissue hanging under gravitational force constant, 9. The centripetal assembly with multiple adhesion sutures performed by rotating the lateral and medial breast quadrants to P1 the point of the intersection of the branch of the triangle and submammary fold creates the breast cone inside out.

The inner part of the tissue is sutured to the muscle fascia of the serratus muscle laterally and the pectoralis major muscle medially Fig. The second suture layer connects the breast tissue deeply to the fascia of Scarpa along the line of the submammary fold. This layer is very strong Fig. This maneuver mobilizes the mammary tissue to the upper pole presenting an effect similar to a mammary prosthesis at the end of the procedure. This approach diverges from the breast tissue assembly as most mammaplasty techniques do.

Basically, current techniques suture the points B and C referring to the remaining breast integument border after resection of the hypertrophy or mastopexy. The method expands the single suture to rotate the lateral mammary quadrant to the second rib arch indicated by some authors. Breast assembly with multiplanar layers starting inside out with multiple adhesion stitches approximating the breast tissue and the pectoralis major muscle.

This helps to give projection to the upper pole and minimizes axillary flaccidity. It does the same intent as techniques used for severe breast hypertrophy or ptosis that either require medial pedicle rotation 25 , 26 or use the areola attached to an inferior pedicle. Lipoplasty under the areola and the upper pole eases NAC repositioning overall in large fat breast. The centripetal rotation of the breast lateral and medial quadrants to P1 minimizes the axillary laxity, contributes to the transposition of the NAC, and adds volume to the upper pole.

This contributes to NAC elevation and gives fullness to the upper pole.

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Breast divine

Breast divine

Breast divine

Breast divine

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Breast divine