Breast Lift - How Long Does the Horizontal Incision Extend?

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. 

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.

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 length of the horizontal incision in a breast lift (mastopexy) varies depending on the specific technique used by the plastic surgeon and the patient’s individual anatomy and needs. Typically, the horizontal incision extends along the natural crease underneath the breast (the inframammary fold). In many cases, this incision is relatively short, often spanning just a few inches across the lower portion of the breast.
However, in some situations, such as when there is significant sagging or when combined with a breast reduction or augmentation, the incision might be longer to allow for more extensive reshaping and lifting. The exact length and placement will be determined by the plastic surgeon’s assessment and the desired outcome, aiming to balance minimal scarring with optimal results.
It’s important to discuss your specific goals and concerns with your plastic surgeon, who can provide more precise information tailored to your case.

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.

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.

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.

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. 

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

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,
peterejohnsonmd