Ideally breasts should not look square following any kind of mastopexy surgery, regardless of technique. By ‘square’ I presume you are referring to a flattened appearance across the lower pole, rather than the gently curving, rounded lower pole of a natural-appearing breast. A ‘square’ lower pole shape can happen with both the traditional mastopexy pattern of scars (inverted-T or ‘anchor’) and with vertical scar (‘short scar’ or ‘lollipop scar’) techniques, with or without simultaneous implant placement. It isn’t usually the skin incision pattern that makes the difference in lower pole appearance, but rather what is done with the lower pole breast tissue (or lack thereof) below the skin. The appearance of the lower pole will be determined both by your surgeon’s preoperative planning and by their intraoperative decision-making. In a mastopexy-only surgery, one must be cautious not to over-resect (remove) central lower pole tissue. It requires a ‘just right’ approach to modification of the lower poles – removing too little lower pole tissue leaves the breast looking bottomed out, while removing too much tissue leaves the lower pole flattened or ‘square’ in appearance. One must be especially cautious in patients with lower pole hypoplasia – a term that plastic surgeons use to describe breasts where the lower poles are underdeveloped. Most patients with lower pole hypoplasia require little to no removal of lower pole tissue at the time of mastopexy. Often these patients require the placement of breast implants immediately prior to mastopexy to augment lower pole volume. When an augmentation mastopexy is performed (breast implant placement + breast lift), the lower pole usually is slightly over-tightened - intentionally - so that the lower pole can support the weight of an implant without ‘bottoming out’. The lower poles may appear slightly flattened for the first days or weeks postop, but they will gradually expand over time. Again, one must be very careful about the amount of lower pole tissue removal and lower pole tightening when performing augmentation mastopexy, as ‘too loose’ will allow the implants to bottom out over time, while ‘too tight’ will leave the breasts appearing square at the bottom. Make sure you review numerous mastopexy and/or augmentation mastopexy ‘before and after’ photos when selecting a surgeon for these procedures. You should see lower pole contours that are consistently round, natural-appearing and aesthetically ideal.