Clin Plastic Surg 29 (2002) 401 – 409
The L short-scar mammaplasty
Armando Chiari Jr, MD*
Department of Surgery, Medical School of the Federal University of Minas Gerais, 190 Av Alfredo Balena,
Sala 4000, Belo Horizonte, Minas Gerais 30130 100, Brazil
Division of Plastic Surgery, The Hospital Ortocenter, 648 Rua Gráo Pará, Belo Horizonte, Minas Gerais 30150 341, Brazil
Since the beginning of the 20th century, many
authors [1 – 15] have attempted to avoid incisions on
the medial portion of the breasts. This goes beyond
the shortening of the horizontal incisions of the
classical inverted-T techniques. By using a different
way of operating on breasts, we seek reduced scars,
but also adequate reduction, good projection, shape,
symmetry, and well-positioned scars.
This mammaplasty technique was developed to
place the resultant vertical scar accurately. To reach
this goal, I use the midsternal line to delimit the
amount of skin and mammary tissue necessary to
reshape the medial and lateral portions of the breasts
[4,5,14]. By using this technique, I have obtained not
only very well-positioned scars, but also breasts with
good projection, shape, and symmetry.
Technique
The marking is based on the design of the main
medial line BC and the more superiorly placed lateral
line B’C’ (Figs. 1,2). After resection, these lines are
sutured together, forming the vertical scar and a
lateral dog ear (Figs. 3,4). If excised, this dog ear
will originate the horizontal stem of the L scar. If not
excised, the compensation of BC and B’C’C will
originate a vertical scar.
* Address for correspondence: Rua Aureliano Lessa
500 – Jaragua, Belo Horizonte, Minas Gerais 31270 200,
Brazil.
E-mail address: armando@chiari.com.br (A. Chiari).
0094-1298/02/$ – see front matter D 2002, Elsevier Science (USA). All rights reserved.
PII: S 0 0 9 4 - 1 2 9 8 ( 0 2 ) 0 0 0 0 4 - 4
Markings
The midsternal and midmammary lines are
marked with the patient standing.
Point A is the projection of the inframmamary
fold on the midmammary line, and point A’ is marked
2 cm above point A (Fig. 1).
The patient is then placed supine, and all the sub-
sequent marks are made with the skin under tension.
Point C is marked at a distance of 8 cm from the
midsternal line, and 1 cm above the inframammary
sulcus (Fig. 1). Point B is placed 11 cm from the
midsternal line and 8 cm above point C (Fig. 1). Point
B’ is marked at the level of the nipple, and the
distance of the areola is determined by sensitivity.
Opposing point B to point B’ we show the new breast
cone, which must have a good projection without
tension. Point C’ is marked 8 cm from point B’,
originating line B’C’C, with the skin of the lateral
portion of the breast under tension, in a superior and
medial direction (Fig. 2).
These are average measurements. According to
the size of the patient and to what they want regard-
ing the size of their breasts, the measurements may
vary proportionally. For instance, as far as a taller
patient with a broader chest is concerned, the meas-
urements 8 and 11 cm might become 9 and 12 cm or
10 and 13 cm (Figs. 1,2).
The surgeon should check the adequacy of the
markings by bidigital maneuvers, bringing together
lines BC and B’C’. Line B’C’ may have its position
changed, according to the surgeon’s feeling. In larger
hypertrophies and ptosis, that change is usually to a
more cranial position, making the dog ear resection
bigger and the periareolar deepithelialization smaller.
402 A. Chiari / Clin Plastic Surg 29 (2002) 401–409

Fig. 1. The main lines BC and B’C’ will be sutured together and will originate the vertical scar, which will be placed accurately.
This allows the operated breasts to be centered on the chest wall. Point C lies 8 cm from the midline and 1 cm above the
submammary sulcus. Point B lies 11 cm from the midline and 8 cm above point C. The markings are drawn with the skin under
tension.

Fig. 2. Point B’ is marked at the level of the nipple. Point C’ is marked 8 cm from point B’, originating line B’C’C, with the
lateral breast skin under tension in a superior medial direction (arrow).
 A. Chiari / Clin Plastic Surg 29 (2002) 401–409 403

Fig. 3. The glandular resection is done with a 60-degree incision down to the chest wall. To obtain the vertical scar, I use
compensation to suture BC to B’C’C, which is longer. If B’C’C is much longer, I suture BC to B’C’, and the treatment of a
lateral dog ear is necessary.

Regarding these larger breasts, the previous resection at the pectoralis fascia. In breasts with firm par-
of the lateral dog ear [4] is also recommended. enchyma, an incision or a resection of the necessary
amount of breast tissue is made along a line from
point B toward the contralateral axila (Fig. 3). The
Surgical technique bases of both pillars should be resected, leaving a
pillar height of 7 to 8 cm (Fig. 3). Care is taken to
I begin the operation with the patient in a supine preserve the lateral intercostal nerve branches [4].
position. The skin surrounding the areolas is deep-
ithelialized (Figs. 1,4). The skin is incised along
lines BC and B’C’C (Fig. 3). A little flap of
glandular tissue [13] is dissected beneath point C
to avoid retractions and to fix the end of the vertical
scar at the level of the inframammary fold. The
breast is then extensively undermined from the
inferior margin of the pectoralis major muscle to
the superior breast border (Fig. 3). Laterally, the
dissection continues to the third, fourth, and fifth
intercostal nerves; medially, it continues to the level
of the anterior cutaneous branches of the same
intercostal nerves [4].
The patient is placed in a semisitting position in
order to project the breasts anteriorly for the par-
enchymal resection. The breast is retracted upward at Fig. 4. When necessary, the resection or only the de-
point A. Glandular incisions along lines BC and epithelialization of a more ‘‘vertical’’ dog ear will originate
B’C’C converge at an angle of 60° (Fig. 3) and meet the short horizontal stem of the L scar.
404 A. Chiari / Clin Plastic Surg 29 (2002) 401–409

Fig. 5. A 27-year-old patient before (A,C) and 1.0 years after resection (B,D) of 220 gm from the left breast and 290 gm from the
right breast. Resulting vertical scar (both breasts).
 A. Chiari / Clin Plastic Surg 29 (2002) 401–409 405

Fig. 6. A 16-year-old patient before (A,C) and 6 months after resection (B,D) of 280 gm from the right breast and 320 gm from
the left breast. Resulting vertical scar at right and L scar at left.
406 A. Chiari / Clin Plastic Surg 29 (2002) 401–409

Fig. 7. A 22-year-old paient before (A,C) and 1 year after resection (B,D) of 330 gm from the right breast and 390 gm from the
left breast. Resulting vertical scar (both breasts).
 A. Chiari / Clin Plastic Surg 29 (2002) 401–409 407

Fig. 8. A 16-year-old patient before (A,C) and 6 months after resection (B,D) of 410 gm from the right breast and 370 gm from
the left breast. Resulting L scar (both breasts).
408 A. Chiari / Clin Plastic Surg 29 (2002) 401–409

Fig. 9. A 17-year-old patient before (A,C) and 14 months after resection (B,D) of 570 gm from the right breast and 520 gm from
the left breast. Resulting vertical scar (both breasts).

Beginning at the bases, the medial and lateral
pillars are sutured together, opposing BC to B’C’C.
To obtain the vertical scar, I use compensation to
suture BC to B’C’C, which is longer (Figs. 1,3,4). If
B’C’C is much longer, I suture BC to B’C’ and resect
the resulting dog ear. The deepithelialization only of
the dog ear is an option for smaller scars (Fig. 4). In
greater hypertrophies and ptosis, I use superficial
liposuction in the lateral portion of the breast to
accommodate the skin [5].
The new areolar position is marked and deep-
ithelialized with A’ as the vertex [4] (Fig. 1,3,4).
Discussion
Since 1988, I have operated on 911 patients
aged 13 – 68 years. My experience of many years
using a superomedial transposition flap and manu-
evers to preserve the lateral intercostal nerves
 A. Chiari / Clin Plastic Surg 29 (2002) 401–409
shows the attainment of good sensation and safety.
Since 1999, the transposition flap has been larger
(Figs. 1,3), medial-superior-lateral, and (I think)
the results will be even better. Although many
patients have breastfed their babies without prob-
lems, the success rate of postoperative breast feed-
ing is unknown.
Lines BC and B’C’ are drawn on distended skin,
with a length of 8 cm (Figs. 1,2). With the breast
remodeled and without the skin distended, the ver-
tical stem of the scar will have an average length of
6.0 cm (Fig. 4).
The technique has yielded uniformly good results
even in patients who need resections of 600 – 900 gm,
especially if their skin elasticity is good. Severe ptosis
and insufficient elasticity of the skin will contribute to
less than ideal postoperative aesthetics. Patients pre-
senting these characteristics will often require a
secondary revision if this technique is chosen.
No hematomas developed. There was a minimal
loss of areola in 6 out of 1819 breasts (911 patients).
In three patients, surgery was performed on only
one breast.
Since 1999, at least 70% of my patients have had
a significantly shorter L scar or a vertical scar,
without surplus skin in the inferior pole (Figs. 5 – 9).
References
[1] Bozola AR. Mamoplastia em ‘‘L’’: contribuicß ão pes-
soal. Rev AMRIGS 1982;26:207 – 14.
409
[2] Bozola AR. Breast reduction with short L scar. Plast
Reconst Surg 1990;85:728 – 38.
[3] Chaves L, Cerceau M, Magalhãles H. Mastoplastia em
‘‘L’’: um novo desenho. Rev Soc Bras Cir Plast 1988;
3:40 – 8.
[4] Chiari A Jr. The L short-scar mammaplasty: a new
approach. Plast Reconst Surg 1992;90:233 – 46.
[5] Chiari A Jr. The L short-scar mammaplasty. 12 years
later. Plast Reconst Surg 2001;108:489 – 95.
[6] Dufourmentel C, Mouly R. Plastie mammaire par la
methode oblique. Ann Chir Plast 1961;6:45 – 58.
[7] Hollander E. Die operation der mammahypertrophie
und der hängebrust. Dtsch Med Wochenschr 1924;
50:1400 – 2.
[8] Horibe K, Spina V, Lodovici O. Mamaplastia reduc-
tora: nuevo abordaje del metodo lateral obliquo. Rev
Lat Am Cir Plast 1976;2:7 – 12.
[9] McCulley SJ, Rousseou TE. A modified Chiari L
short-scar mammoplasty: the technique and results.
Br J Plast Surg 1999;52:112 – 7.
[10] Meyer R, Kesselring UK. Reduction mammaplasty with
an L-shaped suture line. Plast Reconstr Surg 1975;
55:139 – 48.
[11] Meyer R. ‘‘L’’ technique compared with others in
mammaplasty reduction. Aesth Plast Surg 1995;19:
541 – 8.
[12] Regnault P. Reduction mammaplasty by the B tech-
nique. Plast Reconst Surg 1974;53:19 – 24.
[13] Ribeiro L, Baker E. Mastoplastia com pediculo de se-
guridad. Rev Esp Cir Plast 1973;6:223 – 34.
[14] Seidel S, Grotting J, Chiari A Jr: The L short-scar
mammaplasty. In; Spear S, editor. Surgery of the
breast: Principles and art, ed 1. Philadelphia: Lippin-
cott-Raven Publishers. 1998; p 793.
[15] Sepúlveda A. Tratamento das assimetrias mamárias.
Rev Bras Cir 1981;71:11 – 8.