Breast Lift - How Long Does the Horizontal Incision Extend?

I've lost around a 120 pounds with 30 more to go. I have some loose skin near the side of my breast right under my pit. Would this require a longer horizontal breast incision? I've only had one consultation so far. The doctor said he'd need to do a Wise Pattern breast lift. What does this mean?

[Photo removed by request of user]

Doctor Answers 11

The length of breast lift scars depends on the amount of skin to be removed!

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During a breast lift (mastopexy), the breast tissue beneath the skin is rearranged in a three-dimensional fashion, to reshape the breast itself.  This is actually the most important part of the operation.

In addition to this, excess skin must be removed, and the skin surrounding the breast tissue must be re-draped.  In a very droopy breast, this is referred as "re draping the crepe".

Since most breast lifts involve both a reduction of the "skin envelope" both vertically and horizontally (i.e. a 3-D reduction of skin to mirror the 3-D reshaping of the breasts), both a vertical and horizontal scar must be created.  This is in addition to a circular scar around the nipple and areolar complex.

The vertical scar ends downward from the bottom of the areola to the breast fold.  The horizontal incision lies just within the breast fold, also known as the "inframammary fold" (IMF).

The length of the horizontal scar depends on the width of your breast, the amount of redundant skin you have to be reduced, and how much additional tissue or fat you have on the sides - known as the "lateral breast" or "axillary roll" area.

Very often, if you have additional fat here, liposuction may be done at the same time to help shape this area, and to enable the IMF scars to be as short as possible.

Either way, all scars from a breast lift are usually hidden in a triangle-top string bikini, and certainly in all your undergarments!  Remember that it takes at least a full year until your scars are completely "mature" (soft, flat, faded).

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

San Francisco Plastic Surgeon

How far should a breast reduction scar go around the body

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Every individual is different but the key to how far the inframammary scar should extend around the torso is dependent on each patient.  You have lost 120 pounds and are planning on losing a total of 150 pounds.  Your photographs were taken with your left arm lifted  which hikes up the involved skin.  To determine the length of the scar your breast should be view with your arms at your side and see where your breast crease leaves your torso (it iresembles a "j").   This point is where your incision should stop.  I have seen patients where the fold extends half way around to the back.    Send another picture after you have lost all your weight.  

A Wise incision resembles  Poppie's anchor.  The incision is around the areola and then down from the areola at 6 o'clock to the inframammary fold crease.  In the crease it  extends from the medial portion to the lateral portion depending how much redundant skin is present.

Gary H. Manchester, MD (retired)
San Diego Plastic Surgeon

Scarring associated with Breast Lift

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Typically a "wise-pattern" breast lift involves tissue tightening in all dimensions, with resulting scarring around the nipple, down the lower half of the breast and completely under the natural breast fold (inframammary crease). The inframammary crease, horizontal incision, needs to follow the complete length of your natural fold. If you stop short, a "dog-ear", or skin pucker, results from excess skin beyond the level of the scar. When there is extra skin and/or fat folding around the sides, sometimes the scar can be lengthened to remove excess tissue fullness there. Your plastic surgeon will show you where the scars will be. 

Horizontal Incision Extend

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Thanks for the photo. The "Wise" incision pattern is the key hole techniques or anchor. Yes I would extend the incision to the posterior axillary line. Seek further opinions. 

Removing excess skin along bra strap

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Hi Mittsy,

A Wise pattern skin excision results in an anchor pattern scar.  There is a circular scar at the edge of the areola, a vertical scar from the bottom, center of the areola to the breast fold/crease, and a scar along the inframammary fold (breast crease).  As far as the extra skin is concerned, it depends on whether or not it extends from the breast fold. In the photo it looks like this fold is distinctly separate from the breast.  If this is the case, with your resting at your side, then it would be excised separately.  The location of the scar would be placed so that it would be hidden by your bra strap (if possible).  If it blends with your breast, it can be removed by extending the inframammary fold scar.  Hope this helps.

Tracy M. Pfeifer, MD, MS

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

Breast Lift Incisions

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Breast lift incisions involve:

1.  An incision around your areola.  If you have a large areole, this can also be used to make a smaller one.  This also allows the lifting of the nipple and areola.

2.  An incision between your areola and the breast crease (under the breast).  This allows for the breast tissue to be lifted.  This is sometimes referred to as a "lollipop" incision.

3.  In most cases, such as yours, an incision is made along the breast crease (such as in your picture) to help shape the breast.  This is sometimes referred to as an "anchor incision."

All breast lift techniques, including the "Wise Pattern" incorporate all of these incisions to some extent.

The WISE pattern breast lift

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Breast lift can take many forms depending on the position of the nipple relative to the fold under the breast, and the relative skin laxity. Most often a vertical or short scar breast lift will suffice, however if the skin is quite lax as in significant weight loss, the WISE pattern will reduce the skin excess the greatest amount. The WISE pattern is an inverted 'T' with the resulting scar within the fold under the breast and the stem extending from the center of the fold to the nipple. The horizontal scar length will depend on the length of the fold and excess at the bottom of the breast and can be extended as needed.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast Lift and Horizontal Incision?

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Congratulations on your significant weight loss.

Most patients who have had this degree of weight loss benefits from breast lifting surgery (plus or minus breast implants);  often this surgery involves removing skin along the vertical and horizontal dimensions.  This is what the surgeon was referring to as the Wise pattern.  The horizontal incision extends to the side as far as necessary to remove loose skin.  Most patients prefer to have a scar on the lateral chest area as opposed to excess skin and/or adipose tissue. This trade-off of scar for improved contour is commonly seen with plastic surgical procedures.

I hope this helps.

SEE VIDEO BELOW: Horizontal scar for breast lift aka anchor lift aka Wise or Lexer pattern lift (mastopexy)

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A Wise pattern lift is another name for a vertical/horizontal lift or Lexer pattern or more commonly known as the anchor. Your excess upper back skin may require a back lift extending all the way around the upper back beneath the bra strap or extension to the arm also known as a thoracobrachioplasty.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Incisions for breast reduction

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There are several methods available for performing a breast reduction, and they involve different locations and placement of scars. A Wise pattern reduction includes an inframammary scar, placed under the breast. It may be extended laterally to remove excess skin at the side of the breast.

Olivia Hutchinson, MD
New York Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.