Each surgeon will have a technique that they use to locate the final NAC position. There is no right or wrong way to do so as long as the end result achieved looks right. Almost all surgeons will mark the location preoperatively. But some do not commit to the marking until well into the procedure. Others trust the pre-op markings completely and commit immediately. The preoperatively plan is quite important regardless of the technique utilized.
There is no absolute answer. Some surgeons mark beforehand and follow them almost every time. Some mark the vicinity and allow for alterations based on things in the operating room. Most, I would guess, make some sort of check in the operating room to make sure that they are in the right place before absolutely committing to a particular height or location. In other words, the art of the process happens in the OR but the science guides the process preoperatively.
ideal position of the nipple areola complex is halfway between the shoulder and
elbow. Unfortunately, the Wise pattern
does not allow you to select that. The
nipple is placed where it lies after breast repositioning is done. This is one of the many disadvantages of the
Wise pattern. Other disadvantages are nipple
numbness, inability to breast feed and the ugly vertical scars. For that reason, a new technique was
developed called The Ultimate Breast ReductionTM. This technique avoids the ugly vertical
scars, maintains nipple sensation and the ability to breast feed. The nipple is repositioned halfway between
the shoulder and the elbow, the breasts are reshaped creating upper pole
fullness, elevated higher on the chest wall and more medial to increase your
cleavage. The breasts can be reduced to
the size desired by the patient rather than excessive reduction to meet
insurance criteria. The Ultimate Breast
ReductionTM transfers the weight of the breast to the underlying
muscle resulting in immediate pain relief.
Gary Horndeski, M.D.
Thank you for your question. Usually, the breasts are marked with the patient awake, sitting or standing upright, prior to the procedure. Markings include the position of the NAC. However, all surgeons are different, so I would discuss this with the plastic surgeon you choose prior to the procedure to better understand his method.
In all aspects of plastic surgery procedures, there may be different methods that different plastic surgeons utilize. In my practice, and most plastic surgeons' practices I know, breast reduction pre operative markings allow for measurements and planning/positioning of the nipple/areola complexes. Best to run this question by your chosen plastic surgeon for accurate/relevant information. Best wishes.
I always mark my reduction patients pre-op based on where I would like to see the NAC post-op. The final determination is made during the procedure, but any difference is usually very slight and the pre-op marking is important.