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A Process for Quantifying Aesthetic and Functional Breast Surgery: I. Quantifying Optimal Nipple Position and Vertical and Horizontal Skin Excess for Mastopexy and Breast Reduction

Tebbetts, John B. M.D.


In the July 2013 Cosmetic article by John B. Tebbetts, M.D., “A Process for Quantifying Aesthetic and Functional Breast Surgery: I. Quantifying Optimal Nipple Position and Vertical and Horizontal Skin Excess for Mastopexy and Breast Reduction” ( Plast Reconstr Surg . 2013;132:65–73), reference 13 was printed incorrectly. Where reference 13 is cited in text, reference 10 [Lee MR, Unger JB, Adams WP. Process approach to augmentation mastopexy: The tissue-based triad algorithm (submitted for publication)] should have been cited instead. This erroneous reference was introduced to the completed manuscript in error, and the publisher regrets this error.

Plastic and Reconstructive Surgery. 132(4):1040, October 2013.

Plastic and Reconstructive Surgery: July 2013 - Volume 132 - Issue 1 - p 65–73
doi: 10.1097/PRS.0b013e3182910b0a
Cosmetic: Original Articles
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Background: This article defines a comprehensive process using quantified parameters for objective decision making, operative planning, technique selection, and outcomes analysis in mastopexy and breast reduction, and defines quantified parameters for nipple position and vertical and horizontal skin excess. Future submissions will detail application of the processes for skin envelope design and address composite, three-dimensional parenchyma modification options.

Methods: Breast base width was used to define a proportional, desired nipple-to–inframammary fold distance for optimal aesthetics. Vertical and horizontal skin excess were measured, documented, and used for technique selection and skin envelope design in mastopexy and breast reduction. This method was applied in 124 consecutive mastopexy and 122 consecutive breast reduction cases. Average follow-up was 4.6 years (range, 6 to 14 years).

Results: No changes were made to the basic algorithm of the defined process during the study period. No patient required nipple repositioning. Complications included excessive lower pole restretch (4 percent), periareolar scar hypertrophy (0.8 percent), hematoma (1.2 percent), and areola shape irregularities (1.6 percent). Delayed healing at the junction of vertical and horizontal scars occurred in two of 124 reduction patients (1.6 percent), neither of whom required revision. The overall reoperation rate was 6.5 percent (16 of 246).

Conclusions: This study defines the first steps of a comprehensive process for using objectively defined parameters that surgeons can apply to skin envelope design for mastopexy and breast reduction. The method can be used in conjunction with, or in lieu of, other described methods to determine nipple position.

Supplemental Digital Content is available in the text.

Dallas, Texas

From private practice.

Received for publication December 5, 2012; accepted January 22, 2013.

Disclosure:The author has no financial interest to declare in relation to the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (

John B. Tebbetts, M.D., 2801 Lemmon Avenue West, Suite 300, Dallas, Texas 75204,

©2013American Society of Plastic Surgeons