What do we control in mammaplasty for hypertrophic and/or ptotic breasts?

A retrospective view on the history of mammaplasties for hypertrophic and/or ptotic breasts, shows its evolutive sense, in which we attempted to describe the main stages, avoiding to make a long "catalog". The first period (the longest) was marked by progresses concerning the control of vascular security of the areola and the nipple. That stage was essential by the fact it permitted to liberate the attention of surgeons for other questions: those concerning the shape of the breast, means of fixity and the long term evolution, quality and length of scars... In the continuity of this long evolution, each one of the authors presents a personal reflexion about the elements of control (and of course their limits!), developing some concepts as: the supra-medical pedicle for the vascular security, the advantage of the association mammaplasty and breast implant in the long term evolution and attentive post operative care to improve the quality of the scar (J.Ohana); the usefulness of a geometrical methodology-in which the importance of parameters as congruence and base of mammary gland conservation ("BAMACO") for shortening the scar without compromising the quality of the operated breast is demonstrated and with a relatively good stability of correction of the ptosis (-58% after 2 years) (R. Selinger).