**3.2 Vertical scar**

When drawing a vertical scar, a horizontal line is marked between both points A and B, followed by a mediator extending inferiorly to this axis until reaching a point located at mid-distance between the native IMF and both points A and B, named point C. Point C will be joined by two diagonal axes originating from both points A and B (**Figure 3**).

#### **Figure 2.**

*(A-C) when a short T wound closure is planned, the vertical lines are interrupted at 6 cm (point a and B) and continued as diagonal lines pointing both medially and laterally at 45° in opposite directions. To represent the position of the new inframammary fold, these diagonal lines are joined by a line located at mid-distance (named a and b) between the IMF and both points a and B.*

*Power-Assisted Liposuction Mammaplasty (PALM): A Short Scar Mammaplasty… DOI: http://dx.doi.org/10.5772/intechopen.98816*

#### **Figure 3.**

*(A-C) when a vertical scar is planned, a horizontal line is marked between both points A and B, followed by a mediator extending inferiorly to this axis until reaching a point located at mid-distance between the native IMF and both points A and B, named point C. point C will be joined by two diagonal axes originating from both points A and B.*

After the preoperative markings are made on one breast, symmetric markings are made on the contralateral breast by pushing the breasts together and duplicating the periareolar and medial/vertical markings. All of the distances are checked per-operatively to adjust the pre-operative drawings, if judged necessary.

Additional preoperative markings include the zones of liposuction, borders of the superior pocket, position of the dermal-chest wall glandular suspension sutures. The planned superior pocket extends inferiorly to the third rib space, laterally from the pectoralis muscle, medially to 3 cm from the midline, and superiorly to the first rib. The dermal-chest wall sutures extend medially from the second, third, fourth, and sixth rib (**Figure 4**).

Video 1 shows the preoperative markings.

Video 1 PALM markings: https://youtu.be/234SxcYo9eE

#### **Figure 4.**

*(A) The blue dotted line and shading indicate the upper pocket. (B) the glandular excess located in the lower pole is resected (white dotted lines). The gland is rotated 180° supero-medially to lift the breast and fill the previously dissected pocket. (C) the glandular suspension is performed through the placement of a barbed suture passed from dermis to chest wall (solid white line). Suturing extends from the second, third, fourth and sixth rib spaces and is continued laterally from the sixth rib space to the breast axis to recreate the IMF. The numbers indicate the rib spaces.*
