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.

Our ability to achieve good to excellent outcomes following prosthetic breast reconstruction is now commonplace. Complication rates are reduced and aesthetic outcomes are enhanced. Given our ability to achieve these results consistently, predictably, and for the most part reproducibly, many women will focus on what many surgeons would consider minor irregularities. The reality is that contour abnormalities of the breast following prosthetic reconstruction are more common than surgeons realize and constitute the majority of complaints that women have [1]. A common contour abnormality is the scalloping that occurs along the upper lateral aspect of the breast at the junction of the device and the soft tissues. This is frequent in women that have implants or tissue expanders that are placed totally or partially under the pectoralis major muscle. The lateral border of the mastectomy is the anterior axillary line but this may be extended in the event of sentinel or total lymph node biopsy. When a tissue expander or implant is positioned in the subpectoral space, the upper lateral edge of the pectoralis major is elevated and often visible, because there is a paucity of soft tissue for adequate camouflage of the pectoral muscle edge. This often results in a scalloped appearance that is difficult to correct. The need for secondary procedures is sometimes necessary and may include autologous far grafting, scar release, or conversion from the subpectoral plane to a prepectoral plane.

In this manuscript, the authors describe a preventative maneuver that is performed at the time of the immediate reconstruction. The technique is simple but clever in that an advancement suture technique is used to recruit adjacent fat from the lateral flank pocket to cover the lateral pectoral area and the superolateral region of the implant. The technique is illustrated in the manuscript and there are several clinical examples demonstrating excellent results.

My opinion regarding this technique is that it will be successful in the majority of patients, especially in those with a mild to moderate generalized lipodystrophy. By redistributing the adjacent fat with advancement sutures, the scalloping deformity can be minimized. It’s efficacy may be compromised in very thin women with a paucity of body fat as well as in women having radical mastectomy or total axillary lymph node dissection in whom the quantity of adjacent fat may be limited.