**4.1 Infiltration**

General anesthesia is administered and then the patient is placed in the supine position with the arms abducted at 45°. The markings are verified and corrected if judged necessary. The zone of deepitheliazation, breast gland, and lower pole of each breast are infiltrated with a solution that contains epinephrine 1:100,000 per liter of normal saline associated with 5 mL of Exacyl® (tranexamic acid) 0.5 g/5 mL using a power-assisted liposuction system (Lipomatic, Eva SP, EUROMI SA, Verviers, Belgium) and a 3 mm multihole cannula [43]. The infiltration volume depends on the breast size, mean 280 mL (range 100 mL to 400 mL).
