Figure 1.

Patient with preoperative macromastia. A. Preoperative view of patient with macromastia who is indicated for a bilateral mastectomy. Left breast has previously been treated with lumpectomy and radiation therapy. B. Preoperative markings. Red markings represent circumvertical mastectomy incision. Blue markings represent Wise pattern and inframammary crease. Dotted lines represent markings hidden behind the ptotic breast. The Wise pattern is adjusted and incised after flap reperfusion and inset are complete to ensure optimal skin envelope redraping. White markings represent location of staples placed to register Wise pattern, which must be preserved through the operation. C. Following completion of the first stage of breast reconstruction with bilateral DIEP flaps, and Wise pattern skin envelope reduction. D. Following bilateral breast reconstruction revision surgery and nipple areola reconstruction and tattooing. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)