Geometric Template for Preoperative Breast Marking: An Innovative Tool Based on Harmonic Proportions

Breast symmetry and harmony remain challenging goals in aesthetic breast surgery. Preoperative marking is fundamental for planning; however, most techniques rely on nipple-areola complex (NAC) distances and subjective visual assessment, often neglecting thoracic width, height, and the true breast footprint. A geometric framework based on harmonic proportions can help standardize preoperative planning and may improve the reproducibility of breast markings.

A two-dimensional geometric template was developed by integrating constant anatomical references (sternum, clavicles, axillary and acromial lines, and umbilicus) with proportional relationships derived from aesthetic and anthropometric studies. The template was calibrated for each patient's using thoracic width and height and was designed to be superimposed on standardized frontal photographs. It guides the NAC position, breast width, upper pole contour, and inframammary fold level. The model was applied in mastopexy and reduction mammaplasty as a preoperative planning and postoperative photographic overlay comparison, as well as a visual aid in resident teaching sessions.

The template was easily incorporated into daily practice using standard clinical photographs and simple digital overlays. Geometric gridlines and proportional curves allowed visualization of the NAC position, breast symmetry, and contour in relation to thoracic dimensions. Repeated overlays facilitated the longitudinal comparison of breast position and shape. During teaching sessions, the template was used as a visual aid to facilitate resident understanding of the geometric relationships between thoracic anatomy, the breast footprint, and marking decisions.

This innovative geometric template offers a simple, visually intuitive tool for standardizing preoperative marking and supporting postoperative photographic overlay comparisons in breast surgeries. It is inexpensive, compatible with existing photographic workflows, and may support training and future digital or artificial intelligence integration. Prospective studies are needed to quantify the impact of these factors on aesthetic outcomes and learning curves.

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