Figure 6.

The pillar closure starts about halfway up the vertical skin opening. The Wise pattern is followed for the parenchymal resection (but not the skin resection) and the pillars should only measure ∼7 cm in vertical height. The rotation of the medial pedicle along with its base rounds out the inferior aspect of the breast (which can occur with the superior pedicle). The inferior border of the medial pedicle now becomes the medial pillar. The pillars are closed with only a few interrupted 3–0 PDS (Ethicon, Markham, Ontario, Canada) or Monocryl (Ethicon, Markham, Ontario, Canada) in the parenchyma. Care must be taken to suture solid fibrous tissue rather than using large constricting sutures in the fat.