Preoperative marking
Size of the breast, areola, and position of the nipple was marked in the upright position pre-operatively in the operation theater.
Marking of Areola (1st marking): In cases with significant increase of areolar diameter, the areolas were marked to be reduced to 2.8-3 cm, i.e. the average diameter of male areola. The nipple position was also estimated at the mid-humerus level just medial to the mid-clavicular line.
Marking of Breast (2nd marking): The breast was marked along the inframammary fold encircling the enlarged breast tissue.
Marking of skin excess (3rd marking): This marking was done in a circular manner, depending on the size and shape of the breast, with a 2-2.2 cm width from the 1st marking [Figure 4a].
Figure 4  (a) Pre-operative marking of areola, breast and skin excess, (b) De-epithelisation of skin excess, (c) Fixation of areola and closure of the de-epithelised area