The Use of the Laser Level to Ensure Symmetry in Aesthetic Breast Surgery

Symmetry is essential in plastic surgery. We rely on measurements taken with a tape
measure and our artistic eye to achieve symmetry during surgery. Extensive research has
been conducted into the optimally aesthetic lengths and heights of various body parts in
plastic surgery, but the methods of implementation remain the same.

When performing mastopexy or breast reduction, the new Nipple Areolar Complex
(NAC) is often marked by transposing the location of the inframammary fold onto the
anterior surface of the breast. Plastic surgeons have been using the range of 19-23 inches
from sternal notch to inframammary fold as the ideal nipple height ever since Westreich’s
landmark paper. (1) However, the process of copying the height of the nipple from one
breast to the other is complicated by the differences in width and projection between
breasts. This traditional method frequently results in nipples that are placed at unequal
heights.

We present a case where we have incorporated the use of the laser level during the preoperative
markings. During the pre-operative markings, the new NAC position on the
right breast was measured at 19 cm from the sternal notch. If we had utilized the same 19
cm distance from the sternal notch on the left breast, the nipple position would have
ended up being too high. We used the laser level to transpose the new position to the
contralateral breast and determined the correct nipple height was actually located at 20
cm from the sternal notch for perfect symmetry. As demonstrated, the use of the laser
level allows us to be more precise for symmetric NAC placement.

Objective breast measurements quantifying volume, shape, and surface area continue to
be important to ensure great aesthetic outcomes in breast surgery. (2) Conventional
methods to identify the location of the new NAC do not account for differences in breast
width and projection, which could lead to NAC that are not leveled, and therefore
unhappy patients.

In our experience, the use of the laser level has been a great addition to our armament to
ensure symmetry during breast surgery. The application of the laser level is not limited
only to breast surgery as it has also been applied to ensure good alignment during other
procedures such as: abdominoplasty, TRAM flaps, and scar revisions.