Inframammary Incision Planning in Breast Augmentation: A Patient- and Implant-Specific Pythagorean Method.

INTRODUCTION: Inframammary incision placement is critical in achieving optimal aesthetic outcomes in breast augmentation, particularly in minimising visible scarring. Despite its importance, no standardised method currently exists to objectively determine the incision location. AIM: This paper presents a modified geometric model based on the Pythagorean theorem to determine the correct nipple-to-inframammary fold (IMF) distance. METHODS: The model incorporates anatomical variables, such as breast tissue thickness, and implant characteristics including gel cohesiveness. RESULTS: The modified model provides a reproducible and individualised incision planning strategy. Soft cohesive implants necessitate a higher initial placement to anticipate postoperative tissue expansion, whereas firmer gels are placed lower to achieve immediate aesthetic ratios. CONCLUSION: This approach integrates geometry with clinical anatomy and implant biomechanics to standardise inframammary incision placement, improving aesthetic predictability and scar concealment. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .