The Sitting, Oblique, Supine (SOS) Marking Technique for Mastopexy and Breast Reduction

  • Fahmy S. Fahmy

Macromastia can cause considerable emotional and physical stress. The problem of macromastia has been the subject of the efforts of many plastic surgeons since late nineteenth century. In United States alone nearly 40,000 women undergo breast reduction each year [1].

Breast reduction presents both artistic and technical challenges. The surgery aims to reduce the vertical and horizontal planes, shape the parenchyma, reposition the nipple—areola complex, and resect redundant skin. The surgery on paired organs has the added challenge of symmetry. The added effect of recumbence alters the shape and position of the breast. The classic breast shape, as we know it, exists in the erect posture. Much of the outcome of our work as plastic surgeons is determined by preoperative planning and designing. The availability of numerous marking techniques of breast reduction and mastopexy and the abundance of further modifications over the last decennia are clear indications that none of these techniques have proved to be ideal.

The majority aim to achieve some degree of precision in determining the angle between the two vertical limbs. This ultimately affects the amount of tissue resected and the postoperative shape. Few, if any, of such techniques have gained total popularity or acceptance by the plastic surgeons. The freehand marking technique is probably the most widely used technique. Devices as templates [2, 3] shaped wires, goniometers, and geometrical techniques have also been recommended [4–9]. Some of these devices have stood the test of time; others have been modified or abandoned.


Plastic Surgeon Breast Reduction Inframammary Fold Sternal Notch Oblique Position 
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Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Fahmy S. Fahmy
    • 1
  1. 1.Department of Plastic SurgeryCountess of Chester HospitalChesterUK

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