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Page 8 of 9 Kotti. Plast Aesthet Res 2018;5:16 I http://dx.doi.org/10.20517/2347-9264.2018.11

usually prefer a less-invasive approach to each case with as few scars as possible, by privileging the round
block technique as described by Benelli or by Brink (with unfortunate rapid limitation of its use ),
[9]
[12]
[11]
deliberately or not, there would be preservation of “natural ptosis” corrected with a “hands up test” positive
or enlargement of the round scar. Therefore, we prefer the vertical approach for a breast lift, as described
by Lassus , or mastopexy using the chignon technique as described by Kotti instead of the inverted T
[14]
[13]
approach. However, as we believe that our algorithm must respect the patient’s wishes as to final volume, the
final scars and the respect of the presence or absence of a natural ptosis, we also believe that it must respect
the surgeon’s training and the diversity of the effective surgical procedures described in the literature to find
final balance that serves the cause of the ptosis treatment and respects a universal beauty criterion.

We propose a classification that is:

- Simple: without measurements,
- Reproducible: with a simple clinical maneuver without the use of any special devices and,
- Efficient: the breast is analysed in a frontal view, not lateral views, as it is seen in daily social life.

We also propose an appropriate treatment algorithm for every situation that takes the patient’s wishes and
expectations into account and obeys plastic surgery principles without excluding any surgical technique in
order to adapt to the various surgeons’ approaches and preferable procedures.

DECLARATIONS
Authors’ contributions
The author contributed solely to the paper.

Data source and availability
The data presented is original and obtained in our laboratory. It is available with the authors and can be
made available if required.

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
Consents from all of the patients were established prior to submission.

Ethics approval
All treatment and study were performed in compliance with our institutional standard and the Declaration
of Helsinki.

Copyright
© The Author(s) 2018.

REFERENCES
1. Seshadri KG. Obesity: a Venusian story of Paleolithic proportions. Indian J Endocrinol Metab 2012;16:134-5.
2. Zygmont BJ. Venus of Willendorf. Available from: http://smarthistory.org/venus- of-willendorf [Last accessed on 12 Apr 2018].
3. Dufourmentel C, Mouly R. Chirurgie plastique. Paris: Flammarion; 1959. p. 327-70.
4. Lalardrie JP, Jouglard JP. Chirurgie plastique du sein. Paris: Masson; 1974. p. 290.