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A modification of the keyhole pattern for reduction mammaplasty and mastopexy is presented. An inframammary dome with a 3-cm diameter and 6 cm base is inserted on the inframammary fold. The authors believe that this modification reduces the incidence of vertical incision separation and minimizes later " bottoming out " of the surgically reduced/lifted breast. Breast reduction and mastopexy are among the few procedures in plastic surgery that test our ability to achieve superb and long lasting aesthetic results The choice of the appropriate breast reduction technique and attention to fine technical details in planning and execution are very important in determining the outcome of surgery and ultimately, patient satisfaction (1, 2). The inferior pedicle technique and its variations are in wide use thanks to the reliability that the technique offers (3). We present a minor modification of the dependable keyhole pattern with additional technical pearls, proven to be effective in our hands. The senior author has used these modifications in his practice over the last 5 years in 333 patients (161 mastopexies and 172 reduction mam-maplasties) with high patient and surgeon satisfaction. Preoperative markings are made with the patient in the standing position (3). The mid-clavicular line is marked through the nipple. Standard keyhole markings are made and the inframammary fold is then marked. On the miclavicular line an inframammary dome is designed with a 3-cm radius and 6 cm base in the inframammary fold (Figure 1). Note deepithelization of the pedicle, except for the inframammary dome, follows the preoperative markings (4). The new nipple position skin resection is left to be

The inframammary dome-a modification of the keyhole pattern for reduction mammaplasty/mastopexy