All pre-operative markings should be performed with the patient in the erect position allowing the breast to drape naturally on the chest wall.

• The midline should be marked together with the position of the inframammary creases, which can be joined with a horizontal line to achieve symmetry.
• The upper extent of the dissection can be marked as to prevent over dissection of the upper pole.
• IMF incision is commenced between 7 and 8 cm from the midline/sternal notch and is extended laterally following skin tension lines. Incision length is between 3-5 cm.
• Dissection is carried up obliquely through the subcutaneous tissues in an anterior direction through Scarpa’s fascia until the inferolateral border of the pectoralis major muscle is identified.

The inferolateral origin of pectoralis major muscle is grasped with a tissue forceps and the muscle is divided at its origin from the ribs. Dissection is continued superomedially dividing the muscle progressively while securing hemostasis.

• Division directions: from 6 to 4 o’clock on the right side and 6 to 8 o’clock on the left side.
• The subpectoral pocket is then gently dissected assisted by a retractor.

With the pocket size and position established, a temporary breast sizer is inserted to assess final implant volume.

• The tissue pocket is irrigated with saline, antibiotic and local anesthetic solutions.
• Following insertion of the final implant, the soft tissue rim is anchored to the chest wall while making sure to protect the implant with a retractor.
• Skin closure is finally achieved.
• 3-M tape followed by pressure dressing, which is replaced with a bra and elastic wrap for the first week.