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Related Experiment Video

Updated: Mar 12, 2026

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Precise breast implant placement using percutaneous chest wall markings.

Janna Joethy1, Bien-Keem Tan1

  • 1Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.

Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
|November 12, 2016
PubMed
Summary

This study introduces methylene blue dye for pre-operative breast markings, offering a reliable method for accurate breast implant placement. The technique utilizes rib markings to ensure consistent positioning and good symmetry, with no implant-related complications reported.

Keywords:
Breast augmentationbreast implantchest wall markings

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Area of Science:

  • Plastic Surgery
  • Surgical Techniques
  • Medical Imaging

Background:

  • Traditional indelible markers for pre-operative breast markings are prone to removal during surgical preparation.
  • Positional changes and parenchymal alterations can further compromise the accuracy of conventional markings.
  • A novel approach using methylene blue for rib or intercostal markings is presented to improve marking reliability.

Purpose of the Study:

  • To evaluate the efficacy of methylene blue dye for pre-operative breast markings in ensuring accurate implant placement.
  • To assess the reliability and outcomes of a surgical technique utilizing rib markings for breast augmentation.
  • To compare the symmetry and complication rates of breast implants placed using the methylene blue technique.

Main Methods:

  • Pre-operative markings were made on the breast and inframammary crease using an indelible marker.
  • Methylene blue dye was injected in small aliquots (0.1 ml) directly over the periosteum of the rib closest to the inframammary fold.
  • Care was taken to avoid excessive infiltration of local anesthetic to prevent dye diffusion and maintain accuracy.

Main Results:

  • The technique resulted in good symmetry of bilateral breast implants, as evaluated by independent medical officers.
  • Post-operative assessments at 3 months showed all results rated as good or very good.
  • Follow-up for 39 patients ranged from 3 to 24 months, with no implant-related complications observed.

Conclusions:

  • The methylene blue rib marking technique provides a fixed and reliable reference point for accurate breast implant placement.
  • The method utilizes the relative immobility of the ribs to overcome challenges associated with traditional markings.
  • Potential disadvantages were minimal, including two cases of transient dizziness, with no allergic reactions reported.