**3. Preoperative planning and markings**

With the patient in the standing position, preoperative markings are made. The midline, infra-mammary fold, breast axis and anterior axillary lines are drawn. The nipple-to-sternal notch (N-SN) distance for each breast is determined with a measuring meter and then marked directly on the patient. The sternal notch to IMF distance is marked for both breasts, and the shortest length is reported on the breast to identify the position of the new nipple. This point is located 9–11 cm from the midline (distance x), and represents the medial border of the areola. Note that the distance between the lateral border of the areola and the anterior axillary line should always be x + 2 cm (**Figure 1**).

A mosque pattern is utilized to draw the periareolar markings as described by Le Jour et al. [9]. The mosque's circumference depends on the breast size [41, 42];

#### **Figure 1.**

*(A-E) the sternal notch to IMF distance is marked for both breasts, and the shortest length is reported on the breast to identify the position of the new nipple. This point is located 9–11 cm from the midline (distance x), and represents the medial border of the areola. A mosque pattern is utilized to draw the periareolar markings with its circumference ranging from 14 to 16 cm long and 6 to 10 cm wide (line a). The distance between the upper and lower pole of the mosque is represented by the mediator to the line a, and measures 4.2 cm with two third of its length located above the horizontal line.*

it ranged from 14 to 16 cm long and 6 to 10 cm wide (line A). The distance between the upper and lower pole of the mosque is represented by the mediator to the line A, and measures 4.2 cm with two third of its length located above the horizontal line. Rotating the breast superolaterally and then superomedially allows the vertical wound closure lines to be drawn along the breast axis, marking 6 cm from the lower edges of the mosque pattern (point A and B). To indicate the planned vertical wound closure, the lines are joined at the mid-distance between the native IMF and the points A and B (**Figure 1**).

### **3.1 Inverted T or J scar**

When a short T or J 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 horizontal line located at mid-distance (named a and b) between the IMF and both points A and B (**Figure 2**).
