The Pythagorean Theorem as a Tool for Preoperative Planning of a Concealed Scar in Augmentation Mammaplasty with Round Implants

Lesley R. Bouwer, Hanneke J. P. Tielemans, Berend van der Lei*

*Corresponding author for this work

Research output: Contribution to journalEditorialAcademicpeer-review

5 Citations (Scopus)


The inframammary incision is the most versatile and popular approach in breast augmentation. For an optimal aesthetic result, the incision site should be chosen in such a way that the scar is carefully hidden in the (new) inframammary fold. Based on an assumption of the senior author (B.v.d.L.) that the Pythagorean theorem (alpha(2) + beta(2) = gamma(2)) is suited to describe the ratios of implant and incision location variables, the authors developed an almost perfect road-map for accurate determination of the right incision location in augmentation mammaplasty with round implants through the inframammary incision. The authors plenary judged the photographs of 263 augmented breasts whether the scar of the augmentation mammaplasty was located in the neo-inframammary fold. In all cases, the Pythagorean theorem was used to determine the exact location of the site of incision. In only four of the 263 augmented breasts (1.5 percent), the position of the scar was a little below the neo-inframammary fold and thereby visible with the patient in the upright position. A scar correction to reposition the scar into the inframammary fold was performed in one patient on one breast by means of additional skin excision above the scar; in the two other cases, the scar was accepted by the patients as being not too bothersome. The Pythagorean theorem is an effective method for determining the right incision site in augmentation mammaplasty with round implants through an inframammary approach.

Original languageEnglish
Pages (from-to)110-112
Number of pages3
JournalPlastic and Reconstructive Surgery
Issue number1
Publication statusPublished - Jan-2015



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