■ The distance from the nipple to the inframammary fold is measured. By pushing the breast upwards with the palm of the hand in a medial, cranial, and lateral direction, the existing boundaries of the mammary glands are marked. Depending on the findings and on the patient's wishes, the surgeon carrying out the operation draws the extension of the breast boundary in a medial direction (shrinking the intermammary distance), or in a lateral and caudal direction, according to the desired enlargement and change in the form of the breast.
■ It is particularly important to be aware of the inframammary fold, which with appropriate enlargement of the breast must be moved in a caudal direction so that it does not, after the operation, come to rest on the lower breast pole but in the new inframammary fold that is in a lower position.
■ The submammary incision is drawn in the submammary fold, or parallel to this but lower, beginning medially from the vertical extension of the medial areolar boundary to the intended submammary fold. The length in the lateral direction is usually approximately 4 cm and therefore enables the usual types of implants to be introduced easily. The distance E from the lower pole of the nipple to the incision in the subsequent fold
enveloping the breast is dependent on the desired breast size (B, C, D) and therefore on the size of the implant. The larger the implant, the greater the distance. A rule of thumb is that:
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