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Kotti. Plast Aesthet Res 2018;5:16 Plastic and
DOI: 10.20517/2347-9264.2018.11 Aesthetic Research

Original Article Open Access

A simple classification and a simplified treatment’s
algorithm for ptotic breasts

Bouraoui Kotti

Plastic Surgery Department, Medical School of Tunis, Tunis 1007, Tunisia.
Correspondence to: Dr. Bouraoui Kotti, Résidence “Yasmin du lac” Bloc A, Stock exchange avenue, Lake 2, Tunis 1053, Tunisia.
E-mail: contact@drkotti.com

How to cite this article: Kotti B. A simple classification and a simplified treatment’s algorithm for ptotic breasts. Plast Aesthet Res
2018;5:16. http://dx.doi.org/10.20517/2347-9264.2018.11

Received: 24 Feb 2018 First Decision: 4 Apr 2018 Revised: 8 Apr 2018 Accepted: 10 Apr 2018 Published: 25 Apr 2018
Science Editor: Umar Daraz Khan Copy Editor: Guang-Zhe Zhu Production Editor: Cai-Hong Wang

Abstract
Aim: Many classifications have been described in the literature for ptotic breasts, focusing on the nipple areola complex
position compared to the inframammary fold. These use centimeters and lateral views to illustrate their various grades
in a manner always insufficient to propose a clear treatment plan aimed at achieving natural results. We discuss a new
dynamic approach to breast ptosis with a complete treatment algorithm.

Methods: Patients were examined in a standing position first with hands down then with hands up. We observed the
elevation of the inter-nipple line called the “BK-line” and its relationship to a sternal benchmark that we call the "BK-
Point". The "hands-up test" was positive when the line crossed the landmark. The algorithm defines the indication
according to this clinical examination and to the patient's wishes. An angle between the nipple, the “BK-point” and
the body meridian (called the “BK angle”) was appreciated before and after surgery. This angle should become 90° or
more after ptosis treatment.

Results: Three hundred patients were treated for ptotic breasts, including breast reductions, from January 2010 to
September 2017. The definitions of “normal” non-ptotic and ptotic breast and the “ideal” breast were reconsidered.
The surgical indications were adjusted to the clinical situation and to the patient's wishes, refining the final version of
the algorithm.

Conclusion: This new classification is easy, reproducible and efficient. We propose an appropriate algorithm to treat
every situation that takes care to consider patient’s wishes and expectations.

Keywords: Breast ptosis, mammoplasty, vertical lift, mastopexy, breast reduction, breast implant, ptosis classification

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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