Portal de Periódicos da CAPES

Laser Level Projection: A Helpful Tool for Preoperative Markings

2022; Lippincott Williams & Wilkins; Volume: 151; Issue: 2 Linguagem: Inglês

10.1097/prs.0000000000009873

1529-4242

Thomas Holzbach,

Reconstructive Surgery and Microvascular Techniques

Precise preoperative markings are a key element in plastic and reconstructive surgery.1 Surgeons mainly rely on conventional anthropometric measurement of distances in correlation to anatomical landmarks.1,2 In breast surgery, in which correct nipple position is a key factor in the perception of breast symmetry,3,4 we mainly use the suprasternal notch to nipple distance and the midclavicle to nipple distance to determine the correct nipple height.1,2,5 Both distances lack precision. The width of the breast indicates the optimal nipple position in the center of the breast.3 Therefore, different breast widths affect the suprasternal notch to nipple distance without providing a symmetrical height of the new nipple position. The same accounts for the midclavicle to nipple distance. The latter may level out different breast widths to some degree, but may result in incorrect nipple positioning when there is an asymmetry of clavicle height or length. Patients do not tape-measure distances but mainly evaluate the correct nipple position depending on their reflection in the mirror, focusing on the identical height of the nipple-areola complex of both breasts. We started using a commercially available laser projection water-level device for preoperative markings. Our aim is to share our first experiences with this simple and convenient auxiliary tool. To the best of our knowledge, this method has not been reported. We used a commercially available class II laser projection water level (SmartCross Laserliner; Laserliner Schweiz AG, Herisau, Switzerland) with a wavelength of 650 nm, accuracy ±0.50 mm/m, operating distance 0 to 10 m, and autoleveling ±5 degrees, which was mounted on a conventional tripod preoperatively to mark breast reductions, mastopexies, augmentation mastopexies, breast reconstructions, breast symmetrization procedures (Fig. 1), abdominoplasties (Fig. 2), and belt lipectomies. Patients were provided a pair of conventional laser-safety goggles (P1L15, near infrared filter wavelength 650 to 665 nm; Laservision GmbH, Fürth, Germany).Fig. 1.: (Left) Laser-level–assisted preoperative marking before breast symmetrization procedure (right breast, reducing mastopexy; left breast, periareolar mastopexy, unfolding of constricted breast, lipofilling). (Right) Result 6 months postoperatively with exact symmetry of the upper areola border and acceptable asymmetry of nipple height of 2 mm because of discrete areola widening on the right side. Discrete hypertrophic scarring was treated with adhesive silicone patches. Volumetric deviation of 4 percent of breast volume is present in favor of the right breast [right, 270.2 cc; left, 259.8 cc; analyzed with Vectra-H2 3D scan (Canfield Scientific); not shown].Fig. 2.: Preoperative markings for abdominoplasty. Horizontal and vertical lines are used for correct tissue alignment and symmetrical stretch before resection.We find this simple and inexpensive tool (approximate cost $120 to $150 USD, including the tripod) to be safe, quickly installed, and helpful in daily practice. It provides valid and objective information on correct and symmetrical height. This tool also allows an additional measure value in postoperative follow-up for quality control purposes. Whether it can prospectively improve outcomes regarding nipple height or scar symmetry is under investigation. One must be cautious when using this tool when the body surface upon which the laser lines are projected is unevenly contoured (eg, when making preoperative markings on augmented breasts when the implant position is different on either side). Although the irregular implant position will be corrected during the operation, the skin envelope remains unaltered above the new nipple position. In most cases, however, we find the additional information provided by the laser-level projection to be helpful. DISCLOSURE The author has no financial interest to declare in relation to the content of this article.