The surgeon tests the closure tension of the wound sutures by in-folding the breast over the index finger, and towards the transposed nipple-areola complex, to observe if the skin blanches (whitens) or over-stretches, afterwards, the nipple-areola complex-area dermis is de-epithelialized. In the combined mastopexy–augmentation procedure, wherein the breast prosthesis is emplaced to a submuscular implant pocket, an anaesthetic tumescent solution is injected along the marked incision line. When the breast implant will be emplaced to a subglandular implant pocket, the hypodermic needle penetrates un-resisted into the anatomic plane above the pectoralis major muscle; the tumescent solution anaesthesia allows blunt dissection. After establishing anaesthesia, the surgeon de-epithelializes each edge of skin by undermining it , with a razor scalpel, thereby facilitating the closing of the surgical wound without tight sutures. In a mastopexy–augmentation, the breast-implant pocket (locale) determines when the surgeon performs the de-epithelialization of the B pedicle; for submuscular implantation, the skin pedicle de-epithelialization is performed after the emplacement; for subglandular implantation, the skin pedicle de-epithelialization is performed before the emplacement.